Healthcare Provider Details

I. General information

NPI: 1548300296
Provider Name (Legal Business Name): NORTH MISSISSIPPI FOOT SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 CHURCH ST
BYHALIA MS
38611
US

IV. Provider business mailing address

PO BOX 1233
OXFORD MS
38655-1233
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-6600
  • Fax: 662-513-0960
Mailing address:
  • Phone: 662-513-6600
  • Fax: 662-513-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: R MICHAEL WHITMORE
Title or Position: PRESIDENT
Credential: DPM
Phone: 662-513-6600