Fremont Shoe Repair Tru Fit Pedorthics

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

FREMONT SHOE REPAIR TRU FIT PEDORTHICS

Practice address

124 S Stewart Ave
Fremont, MI 49412-1624

Phone

(231) 924-0222

Fax

(231) 924-3855

NPI assigned

Mar 14, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles Thomas Dekryger, C. PED.

Title

President

Phone

(231) 924-0222

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144354283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 S STEWART AVE",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121624",
            "telephone_number": "231-924-0222",
            "fax_number": "231-924-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 S STEWART AVE",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121624",
            "telephone_number": "231-924-0222",
            "fax_number": "231-924-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT SHOE REPAIR TRU FIT PEDORTHICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEKRYGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-924-0222",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C. PED."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Fremont, MI
• Providers in Fremont, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.