Provider Demographics
NPI:1184863391
Name:BROWN'S SHOE FIT CO
Entity type:Organization
Organization Name:BROWN'S SHOE FIT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-2758
Mailing Address - Street 1:1702 W BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2617
Mailing Address - Country:US
Mailing Address - Phone:641-472-2758
Mailing Address - Fax:641-469-5099
Practice Address - Street 1:1702 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2617
Practice Address - Country:US
Practice Address - Phone:641-472-2758
Practice Address - Fax:641-469-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000203558Medicaid