MEDICARE: LA-MISS PODIATRY & FOOT CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	80145	MS
2	213EP1101X	Primary Podiatric Medicine Podiatrist	80145	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245424688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA-MISS PODIATRY & FOOT CLINIC

Provider Business Mailing Address
First Line	:	2429 W COMMERCE ST STE A
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3124
Country	:	US
Telephone Number	:	228-875-1141
Fax Number	:	228-875-6885

Provider Business Practice Location Address
First Line	:	2429 W COMMERCE ST STE A
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3124
Country	:	US
Telephone Number	:	228-875-1141
Fax Number	:	228-875-6885

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE F PHELAN
Credential	:	DPM
Telephone Number	:	601-790-7710

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	02/28/2022

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