Provider Demographics
NPI:1568432219
Name:ANGEL SHOES, INC
Entity type:Organization
Organization Name:ANGEL SHOES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-771-7749
Mailing Address - Street 1:2323 CURLEW RD
Mailing Address - Street 2:STE 6A
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9330
Mailing Address - Country:US
Mailing Address - Phone:727-771-7749
Mailing Address - Fax:727-771-7749
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:STE 6A
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9330
Practice Address - Country:US
Practice Address - Phone:727-771-7749
Practice Address - Fax:727-771-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9687OtherBLUE CROSS
4791600001Medicare NSC