Provider Demographics
NPI:1649021627
Name:PROFESSIONAL FOOTCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:PROFESSIONAL FOOTCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-291-0036
Mailing Address - Street 1:406 BRIARWOOD DR STE 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3063
Mailing Address - Country:US
Mailing Address - Phone:601-977-9002
Mailing Address - Fax:702-977-9005
Practice Address - Street 1:406 BRIARWOOD DR STE 400
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3063
Practice Address - Country:US
Practice Address - Phone:601-977-9002
Practice Address - Fax:702-977-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty