NPIMap

Organization Active NPI

New Balance St.Louis

  • Customized Equipment (DME)
  • Saint Louis, MO
National Provider Identifier
1285872614
Registry record updated May 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
B00029005 Issued in MO
Legal business name
NEW BALANCE ST.LOUIS
Practice address
11633 Olive Blvd
Saint Louis, MO 63141-7001
Phone
(314) 872-2929
Fax
(314) 872-2926
NPI assigned
Jan 22, 2009
Organization subpart
Yes
Parent organization
BROWN'S ENTERPRISES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 19, 2010

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

Authorized official

Name
Mr. Jerry Lee Cook, CPED.
Title
Certified Pedorthist
Phone
(314) 872-2929

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X B00029005 MO
Customized Equipment (DME) 332BC3200X B00029005 MO Primary

Addresses

Primary practice location

11633 Olive Blvd
Saint Louis, MO 63141-7001

Mailing address

11633 Olive Blvd
Saint Louis, MO 63141-7001
Phone (314) 872-2929

National Provider Directory

National Provider Directory
Tax ID family
Browns Family Shoe Stor5 organizations share this tax ID, including this one
Part of
Browns Family Shoe Stor

Other organizations with this tax ID 4

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

Locations

11633 Olive Blvd
Saint Louis, MO 63141
Phone (314) 872-2929

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274227200000",
    "number": "1285872614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11633 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417001",
            "telephone_number": "314-872-2929",
            "fax_number": "314-872-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11633 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417001",
            "telephone_number": "314-872-2929",
            "fax_number": "314-872-2926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW BALANCE ST.LOUIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROWN'S ENTERPRISES INC",
        "enumeration_date": "2009-01-22",
        "last_updated": "2010-05-19",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CERTIFIED PEDORTHIST",
        "authorized_official_telephone_number": "314-872-2929",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPED."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "B00029005",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MO",
            "license": "B00029005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.