1821208372 NPI number — NATCHEZ PODIATRY & FOOT SURGERY PA

Table of content: (NPI 1821208372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821208372 NPI number — NATCHEZ PODIATRY & FOOT SURGERY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATCHEZ PODIATRY & FOOT SURGERY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821208372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228C JOHN R JUNKIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHEZ
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39120-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-446-9850
Provider Business Mailing Address Fax Number:
601-446-9833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228C JOHN R JUNKIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHEZ
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39120-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-446-9850
Provider Business Practice Location Address Fax Number:
601-446-9833
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
601-446-9850

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00115536 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208549785C . This is a "BCBS MS PAYEE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1903906 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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