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Organization
SUMMERS AND KOONCE INC
Active
Organization
SUMMERS AND KOONCE INC
Active
Other names
John Allen Shoes
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY KOONCE CERTIFIED PEDOTHIST (OWNER)
(910) 484-3161
Entity
Organization
Contact information
Practice address
214 OWEN DR, FAYETTEVILLE, NC 28304-3414
(910) 484-3161
(910) 485-6296
Mailing address
214 OWEN DR, FAYETTEVILLE, NC 28304-3414
(910) 484-3161
(910) 485-6296
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
332BC3200X
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045A2
BCBS OF NC
NC
Enumeration date
01/08/2007
Last updated
08/22/2020
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