Provider Demographics
NPI:1396811147
Name:SOLE COMFORT SHOES, INC.
Entity type:Organization
Organization Name:SOLE COMFORT SHOES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS-SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:505-296-1645
Mailing Address - Street 1:11200 MONTGOMERY BLVD NE
Mailing Address - Street 2:#6
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2677
Mailing Address - Country:US
Mailing Address - Phone:505-296-1645
Mailing Address - Fax:505-296-1647
Practice Address - Street 1:11200 MONTGOMERY BLVD NE
Practice Address - Street 2:#6
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2677
Practice Address - Country:US
Practice Address - Phone:505-296-1645
Practice Address - Fax:505-296-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76722OtherBCBS PROVIDER ID NUMBER
NM1285550001Medicare ID - Type Unspecified