Summers and Koonce Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

332BC3200X Issued in NC

Legal business name

SUMMERS AND KOONCE INC

Doing business as

John Allen Shoes

Practice address

214 Owen Dr
Fayetteville, NC 28304-3414

Phone

(910) 484-3161

Fax

(910) 485-6296

NPI assigned

Jan 8, 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

Larry Koonce, CERTIFIED PEDOTHIST

Title

Owner

Phone

(910) 484-3161

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• John Allen Shoes Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528116530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043414",
            "telephone_number": "910-484-3161",
            "fax_number": "910-485-6296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043414",
            "telephone_number": "910-484-3161",
            "fax_number": "910-485-6296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERS AND KOONCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOONCE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-484-3161",
        "authorized_official_credential": "CERTIFIED PEDOTHIST"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "332BC3200X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "045A2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John Allen Shoes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David E Sullivan, LCSW
• Jessica Sullivan
• Juliyahh Alexus Sullivan
• Nijah Sulton
• Summerhill
• Chauntel Marie Summers, PHD
• Latisha M Summers, HAIR LOSS SPECIALIST
• Summit Chiropractic PLLC (Carolina Family Chiropractic)
• Cianee Sumowalt
• Dezmond Bernard Sumter

• Customized Equipment (DME) in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Customized Equipment (DME) in North Carolina

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.