John Marshall Provost, C.PED

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

4244780002 Issued in PA

Practice address

25 Laurel Mall
Provost Shoes
Hazleton, PA 18202-1201

Phone

(570) 455-7704

Fax

(570) 455-7704

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Provost Shoes

  • Durable Medical Equipment & Medical Supplies
  • Hazleton, PA
  • NPI 1447431945
  NPD Authorized official

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992821920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 NORTH ST",
            "city": "W HAZLETON",
            "state": "PA",
            "postal_code": "182023615",
            "telephone_number": "570-455-7704",
            "fax_number": "570-454-6324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 LAUREL MALL",
            "address_2": "PROVOST SHOES",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182021201",
            "telephone_number": "570-455-7704",
            "fax_number": "570-455-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "JOHN",
        "middle_name": "MARSHALL",
        "name_prefix": "Mr.",
        "credential": "C.PED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "4244780002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE EDI BILLING NUMB",
            "identifier": "A08009797",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isaac Michael Porter, PA-C
• Portonova Chiropractic, LLC
• Michael John Portonova, D.C.
• Leocadia T Prawdzik, MD
• Provost Shoes
• George Puhak, DMD
• Janine Pusti, MD
• Syed F Qadri, MD
• George J Racho, MD
• Radiation Medicine Associates of Hazleton PC

• Durable Medical Equipment & Medical Supplies in Hazleton, PA
• Providers in Hazleton, 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 Jul 8, 2007; 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.