Provider Demographics
NPI:1407052319
Name:CENTRAL MISSISSIPPI FOOT SPECIALIST, PLLC
Entity Type:Organization
Organization Name:CENTRAL MISSISSIPPI FOOT SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TAMBURINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,
Authorized Official - Phone:601-824-4700
Mailing Address - Street 1:103 SERVICE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2401
Mailing Address - Country:US
Mailing Address - Phone:601-824-4700
Mailing Address - Fax:601-824-4800
Practice Address - Street 1:103 SERVICE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2401
Practice Address - Country:US
Practice Address - Phone:601-824-4700
Practice Address - Fax:601-824-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80160213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015930Medicaid
4348270001Medicare NSC
MS480000130Medicare PIN
80160Medicare UPIN
MS09015930Medicaid