E. Wagner'S Shoes
Organization Active NPI Prosthetic/Orthotic Supplier · River Forest, IL
NPI 1104983337 · NPPES record last updated Dec 17, 2008
Key facts
- NPI
- 1104983337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Prosthetic/Orthotic Supplier 335E00000X
- License
- 0887330001 (IL)
- Legal business name
- E. WAGNER'S SHOES
- Practice address
- 7379 North Ave
River Forest, IL 60305-1230 - Phone
- (708) 771-4528
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Jerry L. Stout
- Title
- Owner
- Phone
- (708) 771-4528
Practitioners 1
-
Jerry Lee Stout, OST
National Provider Directory
Locations
7379 North Ave
River Forest, IL 60305
Phone (708) 771-4528
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | 0887330001 | IL | Yes |
Addresses
Primary practice location
7379 North Ave
River Forest, IL 60305-1230
Mailing address
7379 North Ave
River Forest, IL 60305-1230
Phone (708) 771-4528
Other providers in River Forest, IL
- Dr Heidi Schwartz PSYD & Assoc PC
- Dr Mary Kelly
- Lucelita Abad Duffy
- Elisabeth Dunne
- Melanie Durolfo-Chavez
- Joseph Edwards
- Elevate Physical Therapy and Fitness, LLC
- Elizabeth R Nye M.D. ,S.C.
- Elizabeth Treatman SLP LLC
- Edith Erber
All providers in River Forest, IL · Prosthetic/Orthotic Supplier in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.