NPIMap

Organization Active NPI

Pacific Footwear Company, Inc.

  • Customized Equipment (DME)
  • Peoria, AZ
National Provider Identifier
1104148741
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
PACIFIC FOOTWEAR COMPANY, INC.
Practice address
13660 N 94TH Dr
Suite F-2
Peoria, AZ 85381-4836
Phone
(623) 302-9396
Fax
(623) 302-9397
NPI assigned
Feb 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin W Clarke
Title
President
Phone
(503) 524-9656

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

13660 N 94TH Dr
Suite F-2
Peoria, AZ 85381-4836

Mailing address

10240 SW Nimbus Ave
Suite L1
Portland, OR 97223-4358
Phone (503) 524-9656

Other names 1

  • Priority Footwear & Pedorthic Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pacific Footwear Company Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13660 N 94th Dr
Ste F2
Peoria, AZ 85381
Phone (623) 302-9396

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1104148741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 SW NIMBUS AVE",
            "address_2": "SUITE L1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972234358",
            "telephone_number": "503-524-9656",
            "fax_number": "503-524-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13660 N 94TH DR",
            "address_2": "SUITE F-2",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814836",
            "telephone_number": "623-302-9396",
            "fax_number": "623-302-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC FOOTWEAR COMPANY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-24",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-524-9656"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Priority Footwear & Pedorthic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.