Provider Demographics
NPI:1306071337
Name:STEPPIN OUT SHOES & ACCESSORIES
Entity type:Organization
Organization Name:STEPPIN OUT SHOES & ACCESSORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WARLEAR
Authorized Official - Middle Name:DESHON
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-691-4805
Mailing Address - Street 1:1985 KROGER DR
Mailing Address - Street 2:SUITE A3
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1771
Mailing Address - Country:US
Mailing Address - Phone:870-732-3364
Mailing Address - Fax:870-732-3364
Practice Address - Street 1:1985 KROGER DR
Practice Address - Street 2:SUITE A3
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1771
Practice Address - Country:US
Practice Address - Phone:870-732-3364
Practice Address - Fax:870-732-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment