Provider Demographics
NPI:1346964137
Name:NATCHEZ PODIATRY PLLC
Entity Type:Organization
Organization Name:NATCHEZ PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-446-9850
Mailing Address - Street 1:PO BOX 18195
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8195
Mailing Address - Country:US
Mailing Address - Phone:601-446-9850
Mailing Address - Fax:601-446-9833
Practice Address - Street 1:151 JEFF DAVIS BLVD STE H
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5140
Practice Address - Country:US
Practice Address - Phone:601-446-9850
Practice Address - Fax:601-446-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115536Medicaid