Lake City Shoe Repair
Durable Medical Equipment & Medical Supplies
3115 N Government Way, #7, Coeur D Alene
Idaho, 83815-3790
208-762-0797 208-762-0791
Lake City Shoe Repair is a Durable Medical Equipment & Medical Supplies in Coeur D Alene, Idaho. It is located at 3115 N Government Way, #7, Coeur D Alene and it's customer support contact number is 208-762-0797. The authorized person of Lake City Shoe Repair is Wayne C Johnson, CPED who is Senior Partnor of this DME and his contact number is 208-762-0797. Active license number of Lake City Shoe Repair is NOT REQUIRED for Durable Medical Equipment & Medical Supplies in Idaho. Lake City Shoe Repair accepts medicare which means medicare covered patients will not be billed for any more than the Medicare deductible and coinsurance.
Lake City Shoe Repair is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
DME Supplier Details:
Lake City Shoe Repair type, location, contact phone number and fax are as below. Patients can directly walkin or can call on the below given customer support phone number for enquiries.
| Name: | Lake City Shoe Repair |
| Type: | Durable Medical Equipment & Medical Supplies |
| Location: | 3115 N Government Way, #7, Coeur D Alene,
Idaho, 83815-3790 |
| Phone: | 208-762-0797 |
| Fax: | 208-762-0791 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this supplier is as below. Person's position and contact details are also mentioned below.
| Name: | Wayne C Johnson |
| Credentials: | CPED |
| Position: | Senior Partnor |
| Contact Number: | 208-762-0797 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given supplier are as mentioned below.
| NPI Number: | 1346629029 |
| NPI Enumeration Date: | 27 May, 2015 |
| NPI Last Update On: | 12 Nov, 2015 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Lake City Shoe Repair are as mentioned below.
| Specialization | License Number | State | Status | |
| Durable Medical Equipment & Medical Supplies | NOT REQUIRED | Idaho | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of this supplier such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 5127610001 | Other | Idaho | Ptan |
Medicare Enrollment:
Lake City Shoe Repair is enrolled in medicare and it's Pac Id, enrollment Id, registered name and type is as stated below.
| PAC ID: |
Enrollment ID: |
Org Name | Medicare Entity Type |
| 5890005409 | O20151111002339 | Lake City Shoe Repair | DME SUPPLIER - MEDICAL SUPPLY COMPANY WITH PEDORTHIC PERSONNEL |
Products Available:
Lake City Shoe Repair has following products available for sale under medicare.
| Products: |
|---|
| • Diabetic Shoes & Inserts: Custom Fabricated | • Diabetic Shoes & Inserts: Prefabricated |
| • Limb Prostheses | • Orthoses: Custom Fabricated |
| • Orthoses: Off-the-shelf | • Orthoses: Prefabricated |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 3115 N Government Way, #7
Coeur D Alene, Idaho |
| Zip: | 83815-3790 |
| Phone Number: | 208-762-0797 |
| Fax Number: | 208-762-0791 |
Patients can reach Lake City Shoe Repair at
3115 N Government Way, #7, Coeur D Alene, Idaho or can
call on customer care at 208-762-0797.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 09 February, 2026.