Active NPI
Vagabond Shoes, Inc.
- Prosthetic/Orthotic Supplier
- Appleton, WI
National Provider Identifier
1861407561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- VAGABOND SHOES, INC.
- Practice address
- 4760 Integrity Way
Appleton, WI 54913-8464 - Phone
- (920) 882-3989
- Fax
- (920) 882-3988
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen M Kelnhofer
- Title
- Owner
- Phone
- (920) 606-0163
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | WI | Primary |
Addresses
Primary practice location
4760 Integrity Way
Appleton, WI 54913-8464
Mailing address
1243 Beechwood CT
Green Bay, WI 54313-7261
Phone (920) 606-0163
National Provider Directory
National Provider Directory- Tax ID family
- Vagabond Shoes Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Prosthetic/Orthotic Supplier
- Green Bay, WI
- NPI 1356441950
Locations
4760 W Integrity Way
Appleton, WI 54913
Phone (920) 882-3989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1861407561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1243 BEECHWOOD CT",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543137261",
"telephone_number": "920-606-0163",
"fax_number": "920-882-3988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4760 INTEGRITY WAY",
"city": "APPLETON",
"state": "WI",
"postal_code": "549138464",
"telephone_number": "920-882-3989",
"fax_number": "920-882-3988"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VAGABOND SHOES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-30",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KELNHOFER",
"authorized_official_first_name": "KATHLEEN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "920-606-0163"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Appleton, WI
Sources for this page
- 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.