Mack Moore Shoes
NPI #1235341173 in Charleston, Illinois
Provider Information
- NPI Number
- 1235341173
- Entity Type
- Organization
- Organization Name
- Mack Moore Shoes
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- May 4, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 305 W LINCOLN AVE
- City
- Charleston
- State
- Illinois
- ZIP Code
- 61920-3020
- Phone
- (217) 345-3479
Authorized Official
- Name
- MR. WILLIAM M MOORE II, CPED
- Title
- GENERAL MANAGER
- Phone
- (217) 345-3479
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
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