Provider Demographics
NPI:1730225954
Name:MONROE'S FAMILY SHOE CENTER INC.
Entity type:Organization
Organization Name:MONROE'S FAMILY SHOE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:JR
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:704-283-5814
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-1216
Mailing Address - Country:US
Mailing Address - Phone:704-283-5814
Mailing Address - Fax:704-289-6767
Practice Address - Street 1:1800 DICKERSON BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2758
Practice Address - Country:US
Practice Address - Phone:704-283-5814
Practice Address - Fax:704-289-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1074Medicaid
NC7702016Medicaid
NC0427XOtherBCBS PROVIDER NUMBER
NC7702016Medicaid