Healthcare Provider Details

I. General information

NPI: 1265601876
Provider Name (Legal Business Name): ROBERT DARRIN HURST DPM WEST TENNESSEE FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 PRATT DR
CORINTH MS
38834-6026
US

IV. Provider business mailing address

129 PRATT DR
CORINTH MS
38834-6026
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-1406
  • Fax: 662-286-1408
Mailing address:
  • Phone: 662-286-1406
  • Fax: 662-286-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number80185
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DARRIN HURST
Title or Position: OWNER
Credential:
Phone: 662-286-1406