Provider Demographics
NPI:1376776435
Name:VERN M. CHRISTENSEN, DPM
Entity Type:Organization
Organization Name:VERN M. CHRISTENSEN, DPM
Other - Org Name:FOOT SPECIALISTS OF MISSISSIPPI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-257-2357
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-0511
Mailing Address - Country:US
Mailing Address - Phone:662-257-2357
Mailing Address - Fax:662-257-2399
Practice Address - Street 1:1107 EARL FRYE BLVD
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5519
Practice Address - Country:US
Practice Address - Phone:662-257-2357
Practice Address - Fax:662-257-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80149213ES0131X
MS80197213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3958280001Medicare NSC