MEDICARE: FOOT CLINIC OF COLUMBUS INC

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	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB7345	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1568588002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT CLINIC OF COLUMBUS INC

Provider Business Mailing Address
First Line	:	PO BOX 2763
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39704-2763
Country	:	US
Telephone Number	:	662-327-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LAWRENCE DR
Second Line	:	SUITE 2
City	:	COLUMBUS
State	:	MS
Zip	:	39702-5319
Country	:	US
Telephone Number	:	662-327-8910
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST OWNER
Name	:	JAMES H KILGORE
Credential	:	DPM
Telephone Number	:	662-327-8910

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	11/11/2008

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