Provider Demographics
NPI:1710027461
Name:NORTH MISSISSIPPI FOOT SPECIALISTS PC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI FOOT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-513-6600
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1233
Mailing Address - Country:US
Mailing Address - Phone:662-513-6600
Mailing Address - Fax:662-513-0960
Practice Address - Street 1:835 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773
Practice Address - Country:US
Practice Address - Phone:662-513-6600
Practice Address - Fax:662-513-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02333593Medicaid