MEDICARE: PROFESSIONAL FOOTCARE SOLUTIONS LLC

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	213ES0131X	Foot Surgery Podiatrist
2	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1649021627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL FOOTCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	406 BRIARWOOD DR STE 400
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-977-9002
Fax Number	:	702-977-9005

Provider Business Practice Location Address
First Line	:	406 BRIARWOOD DR STE 400
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-977-9002
Fax Number	:	702-977-9005

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL BOYKINS
Credential	:
Telephone Number	:	601-291-0036

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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