Provider Demographics
NPI:1194755058
Name:SELIGA SHOE STORES INC
Entity type:Organization
Organization Name:SELIGA SHOE STORES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-961-0110
Mailing Address - Street 1:2530 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2309
Mailing Address - Country:US
Mailing Address - Phone:314-961-0110
Mailing Address - Fax:314-961-0529
Practice Address - Street 1:2530 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2309
Practice Address - Country:US
Practice Address - Phone:314-961-0110
Practice Address - Fax:314-961-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11054832OtherMISSOURI TAX ID
MO11054832OtherMISSOURI TAX ID