E. WAGNER'S SHOES (NPI# 1104983337) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104983337 |
| Entity Type | Organization |
| Organization Name | E. WAGNER'S SHOES |
| Practice Address |
7379 North Ave River Forest IL 60305-1230 |
| Practice Telephone | 7087714528 |
| Mailing Telephone | 7087714528 |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2008-12-17 |
| Authorized Official Name | MR. JERRY L. STOUT (OWNER) |
| Authorized Official Telephone | 7087714528 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 0887330001 | IL | Suppliers |
| Street Address |
7379 NORTH AVE |
| City | RIVER FOREST |
| State | IL |
| Zip Code | 60305-1230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063969004 | Logan N Nierzwicki | Physical Therapist | 7341 A Lake St, River Forest, IL 60305 | 2016-09-07 |
| 1427442292 | Gina Patel | Physical Therapist | 7341a Lake St, River Forest, IL 60305 | 2015-03-19 |
| 1316369630 | Kristin Burns | Social Worker | 1115 Thatcher Ave, River Forest, IL 60305 | 2014-01-07 |
| 1508102823 | Elizabeth Ralyea | Nurse Practitioner | 7251 W Lake Street, River Forest, IL 60305 | 2012-12-13 |
| 1194009175 | Mani Chhibba | Optometrist | 7345 West Lake Street, River Forest, IL 60305 | 2011-10-07 |
| 1508069212 | Fatima Ali Hyder | Internal Medicine | 7343 Lake St, River Forest, IL 60305 | 2007-06-08 |
| 1932314069 | Karen Vanslyck Darley | Dentist | 340 Lathryn Ave, River Forest, IL 60305 | 2007-05-11 |
| 1083836571 | Lucelita Abad Duffy | Physical Therapist | 7411 Lake Street, Rehabilitation & Sports Medicine West Suburban Resurrec, River Forest, IL 60305 | 2007-05-03 |
| 1457484669 | Michelle Annette Melyn | Psychiatry & Neurology | 7777 West Lake St, River Forest, IL 60305 | 2007-03-14 |
| 1588797757 | Marie T Walsh | Dentist | 7765 W. North Ave., River Forest, IL 60305 | 2007-03-14 |
| Find all providers in zip 60305 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909517 | Matayah Love | Prosthetic/Orthotic Supplier | 5833 W Madison St, Chicago, IL 60644-3840 | 2020-10-15 |
| 1225653686 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 1290 W Northwest Hwy, Palatine, IL 60067-1897 | 2020-06-11 |
| 1710508239 | Vivian Danielle Williams | Prosthetic/Orthotic Supplier | 940 N Monticello Ave # 1, Chicago, IL 60651-3949 | 2020-05-06 |
| 1265053136 | Dfined Beauty LLC | Prosthetic/Orthotic Supplier | 1507 E 53rd St # 835, Chicago, IL 60615-4573 | 2020-05-02 |
| 1134748767 | The Weave Luxe Bar | Prosthetic/Orthotic Supplier | 7315 Lemont Rd, Downers Grove, IL 60516-3807 | 2020-04-14 |
| 1245865245 | Ortheco LLC | Prosthetic/Orthotic Supplier | 3050 Montvale Dr Ste E, Springfield, IL 62704-4290 | 2020-03-10 |
| 1417515784 | Dionne Williams Group | Prosthetic/Orthotic Supplier | 6822 S Wood St, Chicago, IL 60636-3337 | 2019-06-03 |
| 1164080743 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 391 Quadrangle Dr Ste N4, Bolingbrook, IL 60440-3443 | 2019-05-30 |
| 1760047583 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 13500 Circle Dr Ste 202, Orland Park, IL 60462-1343 | 2019-05-07 |
| 1114580107 | Thomas Gavin | Prosthetic/Orthotic Supplier | 1010 Jorie Blvd Ste 24, Oak Brook, IL 60523-4450 | 2019-04-16 |
| Find all providers with the same taxonomy | ||||
| City | RIVER FOREST |
| Zip Code | 60305 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.