Provider Demographics
NPI:1366487167
Name:GENE'S SPECIALTY FOOTWEAR INC
Entity type:Organization
Organization Name:GENE'S SPECIALTY FOOTWEAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:636-946-1652
Mailing Address - Street 1:126 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2827
Mailing Address - Country:US
Mailing Address - Phone:636-946-1652
Mailing Address - Fax:636-940-7463
Practice Address - Street 1:126 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2827
Practice Address - Country:US
Practice Address - Phone:636-946-1652
Practice Address - Fax:636-940-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5473000001Medicare NSC
MO5473000001Medicare ID - Type Unspecified