Provider Demographics
NPI:1821208372
Name:NATCHEZ PODIATRY & FOOT SURGERY PA
Entity Type:Organization
Organization Name:NATCHEZ PODIATRY & FOOT SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-446-9850
Mailing Address - Street 1:228C JOHN R JUNKIN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3822
Mailing Address - Country:US
Mailing Address - Phone:601-446-9850
Mailing Address - Fax:601-446-9833
Practice Address - Street 1:228C JOHN R JUNKIN DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3822
Practice Address - Country:US
Practice Address - Phone:601-446-9850
Practice Address - Fax:601-446-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115536Medicaid
MS208549785COtherBCBS MS PAYEE
LA1903906Medicaid
MS00115536Medicaid
LA5W650Medicare PIN
MS5544570001Medicare NSC
LA1903906Medicaid