Provider Demographics
NPI:1306156534
Name:HUNTINGTON COMFORT SHOES AND ORTHOTICS LLC
Entity type:Organization
Organization Name:HUNTINGTON COMFORT SHOES AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:304-525-7463
Mailing Address - Street 1:2516B 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1619
Mailing Address - Country:US
Mailing Address - Phone:304-525-7463
Mailing Address - Fax:304-525-1000
Practice Address - Street 1:2516B 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1619
Practice Address - Country:US
Practice Address - Phone:304-525-7463
Practice Address - Fax:304-525-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
655109001Medicare PIN