Provider Demographics
NPI:1457470296
Name:FOOT SPECIALISTS OF SOUTH MISSISSIPPI PLLC
Entity Type:Organization
Organization Name:FOOT SPECIALISTS OF SOUTH MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-818-2801
Mailing Address - Street 1:PO BOX 6278
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3704 BIENVILLE BLVD
Practice Address - Street 2:SUITE A1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-818-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80130213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116781Medicaid