Organization
BROWN'S SHOE FIT CO. #58
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROY EDWARD TIFF (MANAGER/OWNER)
(660) 665-4062
Entity
Organization
Contact information
Practice address
1716 N BALTIMORE ST, KIRKSVILLE, MO 63501-2485
(660) 665-4062
(660) 665-4062
Mailing address
1716 N BALTIMORE ST, KIRKSVILLE, MO 63501-2485
(660) 665-4062
(660) 665-4062
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/13/2009
Last updated
02/13/2009
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