Organization
COUNTRYSIDE PEDORTHICS & COBBLER SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD G. AUGER CPED (OWNER/CERTIFIED PEDORTHIST)
(860) 546-1099
Entity
Organization
Contact information
Practice address
95 BINGHAM RD, CANTERBURY, CT 06331-1302
(860) 546-1099
(860) 546-1095
Mailing address
95 BINGHAM ROAD, CANTERBURY, CT 06331
(860) 546-1099
(860) 546-1095
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1510
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004069993
—
CT
Enumeration date
10/31/2007
Last updated
04/22/2021
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