Provider Demographics
NPI:1366599581
Name:SHIRLEY'S SHOE SHOPPE INC.
Entity type:Organization
Organization Name:SHIRLEY'S SHOE SHOPPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPED OST
Authorized Official - Phone:814-941-7424
Mailing Address - Street 1:PO BOX 2006
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16603-2006
Mailing Address - Country:US
Mailing Address - Phone:814-941-7424
Mailing Address - Fax:814-941-2118
Practice Address - Street 1:1400 11TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3304
Practice Address - Country:US
Practice Address - Phone:814-941-7424
Practice Address - Fax:814-941-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006405332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6000006405OtherDRUG AND DEVICE PA DEPT
PA3910190001Medicare NSC