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NPI Code Detail

MEDICARE: ADVANCED FOOT CARE CENTER

MEDICARE: ADVANCED FOOT CARE CENTER
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
1213EP1101XPrimary Podiatric Medicine Podiatrist80152MS

Other Identifiers

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

General Provider Information

NPI Number : 1497957120
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED FOOT CARE CENTER
Provider Business Mailing Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-981-3001
Fax Number : 601-981-8999
Provider Business Practice Location Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-981-3001
Fax Number : 601-981-8999
Authorized Official
Title or Position : PODIATRIST OWNER
Name : DR. LARRY R CRUEL
Credential : DPM
Telephone Number : 601-981-3001
Provider Enumeration Date : 06/04/2007
Last Update Date : 08/19/2008

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Directions to “ADVANCED FOOT CARE CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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