Organization
CHAMPION SHOE SALES & REPAIR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA MARIE FICK (PRESIDENT)
(570) 523-0822
Entity
Organization
Contact information
Practice address
119 N 2ND ST REAR, LEWISBURG, PA 17837-1564
(570) 523-0822
(570) 523-0846
Mailing address
119 N 2ND ST REAR, LEWISBURG, PA 17837-1564
(570) 523-0822
(570) 523-0846
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000005305
PA
Other
Enumeration date
07/28/2015
Last updated
10/26/2015
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