E. Wagner'S Shoes
Prosthetic/Orthotic Supplier in River Forest, IL. Organization (NPI-2).
NPI number1104983337
StatusActive
Last updated in NPPESDec 17, 2008
Details
- NPI
- 1104983337
- Entity type
- Organization (NPI-2)
- Legal business name
- E. Wagner'S Shoes
- Organization subpart
- No
- Enumeration date
- Jan 3, 2007
- Last updated
- Dec 17, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | 0887330001 | IL | Yes |
Practice location
7379 North AveRiver Forest, IL 60305-1230
Phone 708-771-4528
Mailing address
7379 North AveRiver Forest, IL 60305-1230
Phone 708-771-4528
Authorized official
Jerry L. Stout
Owner
7087714528
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Checking a whole list?
Paste a list of NPIs and get status, record, Medicare enrollment and OIG exclusion for each one. 100 free a day, then from $5 for 5,000. Useful for credentialing, billing and pharmacy claim checks.