Provost Shoes

NPI #1447431945 in Hazleton, Pennsylvania

Provider Information

NPI Number
1447431945
Entity Type
Organization
Organization Name
Provost Shoes
Primary Specialty
Durable Medical Equipment & Medical Supplies
Enumeration Date
Nov 26, 2007
Last Updated
Dec 5, 2007

Practice Location

Address
25 LAUREL MALL
ZIP Code
18202-1201
Phone
(570) 455-7704

Authorized Official

Name
JOHN M PROVOST, C. PED
Title
OWNER
Phone
(570) 455-7704

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies

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