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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