NPIMap

Organization Active NPI

Pacific Footwear Company, Inc.

Doing business as Priority Footwear & Pedorthic Services

  • Customized Equipment (DME)
  • Bountiful, UT
National Provider Identifier
1861632671
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
PACIFIC FOOTWEAR COMPANY, INC.
Doing business as
Priority Footwear & Pedorthic Services
Practice address
225 N Main St
Bountiful, UT 84010-6135
Phone
(801) 298-1764
Fax
(801) 295-2445
NPI assigned
Mar 6, 2009
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Authorized official

Name
Kevin W Clarke
Title
President
Phone
(503) 524-9656

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X NU Primary
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

225 N Main St
Bountiful, UT 84010-6135

Mailing address

10240 SW Nimbus Ave
Suite L1
Portland, OR 97223-4358
Phone (503) 524-9656

Other identifiers 1

IdentifierTypeStateIssuer
260051087001MedicaidUT

Other names 1

  • Priority Footwear & Pedorthic Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pacific Footwear Company Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

225 N Main St
Bountiful, UT 84010
Phone (801) 298-1764

NPI Registry JSON

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1861632671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 SW NIMBUS AVE",
            "address_2": "SUITE L1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972234358",
            "telephone_number": "503-524-9656",
            "fax_number": "503-524-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106135",
            "telephone_number": "801-298-1764",
            "fax_number": "801-295-2445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC FOOTWEAR COMPANY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-524-9656"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260051087001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Priority Footwear & Pedorthic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.