Champion Shoe Sales & Repair Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

6000005305 Issued in PA

Legal business name

CHAMPION SHOE SALES & REPAIR INC

Practice address

119 N 2ND St Rear
Lewisburg, PA 17837-1564

Phone

(570) 523-0822

Fax

(570) 523-0846

NPI assigned

Jul 28, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Gina Marie FickNPI 1558750224

Title

President

Phone

(570) 523-0822

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gina Fick, CFTS

  • Orthotic Fitter
  • Lewisburg, PA
  • NPI 1558750224
  NPD (past) Authorized official

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

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1245615517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 N 2ND ST REAR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178371564",
            "telephone_number": "570-523-0822",
            "fax_number": "570-523-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 N 2ND ST REAR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178371564",
            "telephone_number": "570-523-0822",
            "fax_number": "570-523-0846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION SHOE SALES & REPAIR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-28",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "FICK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-523-0822",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "6000005305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Penn Mobile Wound Care
• Central Pennsylvania Cardiology Associates LLC
• Central Susquehanna Surgical Specialists, P.C.
• Seth Edward Chamberlain, B.S.
• Shane Chamberlin, BSL
• Anya J Chandler, M.D.
• Julie Marie Charlton, ATC, MPT
• Lukasz Chebes, M.D.
• Garima Chitkara, DMD
• Danny Hyun Cho, MD

• Durable Medical Equipment & Medical Supplies in Lewisburg, PA
• Providers in Lewisburg, PA by specialty
• Durable Medical Equipment & Medical Supplies in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.