Modern Shoe, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MODERN SHOE, INC.

Practice address

350 W Center St
Provo, UT 84601-4323

Phone

(801) 375-2711

Fax

(801) 371-0060

NPI assigned

Nov 15, 2007

Organization subpart

No

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

Authorized official

Name

Anthony C Thomas

Title

President

Phone

(801) 375-2711

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275004800000",
    "number": "1225219587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846014323",
            "telephone_number": "801-375-2711",
            "fax_number": "801-371-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W CENTER ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846014323",
            "telephone_number": "801-375-2711",
            "fax_number": "801-371-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SHOE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2010-05-28",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-375-2711"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Provo, UT by specialty
• Durable Medical Equipment & Medical Supplies in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; 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.