Tri City Shoes LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

TRI CITY SHOES LLC

Practice address

105 Rogers Rd
Glasgow, KY 42141-1601

Phone

(270) 651-8071

NPI assigned

Jul 11, 2005

Organization subpart

No

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

Authorized official

Name

Randy Dunham

Title

Owner

Phone

(270) 651-8071

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1750389078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ROGERS RD",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411601",
            "telephone_number": "270-651-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ROGERS RD",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411601",
            "telephone_number": "270-651-8071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI CITY SHOES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "DUNHAM",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-651-8071"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90006255",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000000577778",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Customized Equipment (DME) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.