Provider Demographics
NPI:1578736856
Name:BRUCE BOYD
Entity Type:Organization
Organization Name:BRUCE BOYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-286-2700
Mailing Address - Street 1:211 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8400
Mailing Address - Country:US
Mailing Address - Phone:662-286-2700
Mailing Address - Fax:662-286-2773
Practice Address - Street 1:211 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8400
Practice Address - Country:US
Practice Address - Phone:662-286-2700
Practice Address - Fax:662-286-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80100332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110447Medicaid
TN3351600Medicaid
TN4563110001Medicare PIN
TN3351600Medicaid
MS4563110001Medicare PIN