MEDICARE: CLEVELAND FOOT CLINIC 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	213EP1101X	Primary Podiatric Medicine Podiatrist	80066	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1578661633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND FOOT CLINIC INC

Provider Business Mailing Address
First Line	:	PO BOX 907
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-0907
Country	:	US
Telephone Number	:	662-843-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 NORTH ST
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2744
Country	:	US
Telephone Number	:	662-843-3668
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LINDA C HICKS
Credential	:
Telephone Number	:	662-843-3668

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/23/2008

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Directions to “CLEVELAND FOOT CLINIC INC ” Practice Location

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