Provider Demographics
NPI:1740309590
Name:MADISON FOOT CLINIC, PLLC
Entity type:Organization
Organization Name:MADISON FOOT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-605-8770
Mailing Address - Street 1:980 HIGHWAY 51 STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8409
Mailing Address - Country:US
Mailing Address - Phone:601-605-8770
Mailing Address - Fax:601-605-8773
Practice Address - Street 1:980 HIGHWAY 51 STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8409
Practice Address - Country:US
Practice Address - Phone:601-605-8770
Practice Address - Fax:601-605-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80153213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122886Medicaid
MS00122886Medicaid