Provider Demographics
NPI:1366610750
Name:DR QUINNS DIABETIC SHOES
Entity type:Organization
Organization Name:DR QUINNS DIABETIC SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN. PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:828-658-0777
Mailing Address - Street 1:80 MORGAN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9638
Mailing Address - Country:US
Mailing Address - Phone:828-658-0777
Mailing Address - Fax:828-658-1992
Practice Address - Street 1:80 MORGAN BRANCH RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9638
Practice Address - Country:US
Practice Address - Phone:828-658-0777
Practice Address - Fax:828-658-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6092850001Medicare NSC