Geo Allen Shoes Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

212-000021 Issued in IL

Legal business name

GEO ALLEN SHOES INC

Doing business as

George Allen Shoes Inc

Practice address

13003 Western Ave
Blue Island, IL 60406-2406

Phone

(708) 388-8570

Fax

(708) 824-2606

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dallas R Powers, C.PED

Title

President

Phone

(708) 388-8570

Specialties & licenses 1

Addresses

Other names 1

• George Allen Shoes Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

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": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1740337427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13003 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062406",
            "telephone_number": "708-388-8570",
            "fax_number": "708-824-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13003 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062406",
            "telephone_number": "708-388-8570",
            "fax_number": "708-824-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEO ALLEN SHOES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-388-8570",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.PED"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "212-000021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "George Allen Shoes Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlyn Alexandria Freidhof
• Mikhail Freidine, MD
• Eiman Yousif Gafour, O.D
• Joaquin Galvan, CRNA
• Karla Garner
• Ehab Taher Awadi Ghandour, DMD
• Nicholas J Gierman, ATC
• Charlotte Amanda Glispie, PHARMD
• Anthony Kelly Goldboss, MD
• Laurie Sue Gordon, DDS

• Customized Equipment (DME) in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Customized Equipment (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.