Dimitri'S Shoe Service,LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DIMITRI'S SHOE SERVICE,LLC

Practice address

209 Conant St
Maumee, OH 43537-3355

Phone

(419) 893-8647

Fax

(419) 893-8694

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Maureen Georgevich, LICENSED PEDORTHIST

Title

Assistant Manager

Phone

(419) 893-8647

Specialties & licenses 1

Addresses

Other names 1

• Red Wing Shoes and Repair Doing business as

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619089992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 CONANT ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435373355",
            "telephone_number": "419-893-8647",
            "fax_number": "419-893-8694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CONANT ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435373355",
            "telephone_number": "419-893-8647",
            "fax_number": "419-893-8694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRI'S SHOE SERVICE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GEORGEVICH",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "419-893-8647",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSED PEDORTHIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Wing Shoes and Repair",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Dick
• Yuriko Dickey
• Katherine Didion, PCC
• Lisa Anne Dille, LPCC
• Heather Janece Dilworth, HS ; RBT
• Nadine Marie Dlugas, RN BSN
• Dominion Health Residential Services LLC
• Cyndel C Donaldson, NP
• Tracey Doughten, RN
• Douglas Borell Counseling Services LLC

• Durable Medical Equipment & Medical Supplies in Maumee, OH
• Providers in Maumee, OH by specialty
• Durable Medical Equipment & Medical Supplies in Ohio

• 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.