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Provost Shoes
Durable Medical Equipment & Medical Supplies in Hazleton, Pennsylvania
NPI 1447431945

Provost Shoes is a Durable Medical Equipment & Medical Supplies based in Hazleton, PA. Provost Shoes practices in Hazleton, PA. The NPI Number for Provost Shoes is 1447431945 and holds a License No. 4244780002 (Pennsylvania).

The current practice location address for Provost Shoes is 25 Laurel Mall, Hazleton, PA and can be reached out via phone at 570-455-7704 and via fax at 570-455-7704.

Location: 25 Laurel Mall, Hazleton, PA, 18202-1201
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1447431945
Provider Name
Provost Shoes
Credential
Provider Entity Type
Organization
Address
25 Laurel Mall, Hazleton, PA, 18202-1201
Phone Number
570-455-7704
Fax Number
570-455-7704
Provider Enumeration Date
11/26/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
A08009797 01 MEDICARE EDI BILLING NUMB
institution
Provider Business Practice Location Address Details
Address
25 Laurel Mall
City
Hazleton
State
Pennsylvania
Zip
18202-1201
Phone Number
570-455-7704
Fax Number
570-455-7704
person
Provider Business Mailing Address Details
Address
25 Laurel Mall
City
Hazleton
State
Pennsylvania
Zip
18202-1201
Phone Number
570-455-7704
Fax Number
570-455-7704
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Durable Medical Equipment & Medical Supplies
Speciality
-
Taxonomy
332B00000X
License No.
4244780002 (Pennsylvania)
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
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