Provost Shoes

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

4244780001 Issued in PA

Legal business name

PROVOST SHOES

Practice address

225 Columbia Mall Dr
Bloomsburg, PA 17815-8368

Phone

(570) 784-4645

Fax

(570) 455-7704

NPI assigned

Feb 25, 2009

Organization subpart

No

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

Authorized official

Name

Mr. John Marshall Provost, C.PED

Title

Owner

Phone

(570) 784-4645

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1972743268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 COLUMBIA MALL DR",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178158368",
            "telephone_number": "570-784-4645",
            "fax_number": "570-455-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 COLUMBIA MALL DR",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178158368",
            "telephone_number": "570-784-4645",
            "fax_number": "570-455-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVOST SHOES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "PROVOST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-784-4645",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.PED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "4244780001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Prial, HIS
• Donna Price, LSW
• Primenest Wellness LLC
• PRN Home Health Services, LLC.
• Cindy A Prosseda, LCSW
• McKenzie Beth Prutsman
• Kirstie Nicole Pysher, PSYD
• Nikki Marie Rabuck
• Eugene D Radice, MD
• Raj P Chopra MD PC

• Durable Medical Equipment & Medical Supplies in Bloomsburg, PA
• Providers in Bloomsburg, PA by specialty
• Durable Medical Equipment & Medical Supplies in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; 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.