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General NPI Number Information
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NPI Number | 1245424688
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Entity Type | Organization
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Legal Business Name | LA-MISS PODIATRY & FOOT CLINIC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 2429 W COMMERCE ST STE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3124
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Country | US
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Telephone | 228-875-1141
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Fax | 228-875-6885
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Provider Business Mailing Address
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Address Line | 2429 W COMMERCE ST STE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3124
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Country | US
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Telephone | 228-875-1141
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Fax | 228-875-6885
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE F PHELAN
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Credential | DPM
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Telephone | 601-790-7710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 80145
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 80145
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License Number State | MS
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