Provider Demographics
NPI:1568588002
Name:FOOT CLINIC OF COLUMBUS INC
Entity Type:Organization
Organization Name:FOOT CLINIC OF COLUMBUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-327-8910
Mailing Address - Street 1:PO BOX 2763
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39704-2763
Mailing Address - Country:US
Mailing Address - Phone:662-327-8910
Mailing Address - Fax:
Practice Address - Street 1:116 LAWRENCE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5319
Practice Address - Country:US
Practice Address - Phone:662-327-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDB7345OtherRAILROAD MEDICARE
MS05276776Medicaid
MS5708140001Medicare NSC
MS05276776Medicaid