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
- City
- Hazleton
- State
- Pennsylvania
- 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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| Provider Name | |
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