| |
104 Partnership Way, Columbia, MS 39429-4502 | |
(601) 268-0400 | |
(601) 264-3150 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 104 Partnership Way, Columbia, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1528440195 | NPI | - | NPPES |
09015719 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 80131 (Mississippi) | Primary |
Mailing Address | Practice Location Address |
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Po Box 16235, Hattiesburg, MS 39404-6235 Ph: (601) 268-0400 | 104 Partnership Way, Columbia, MS 39429-4502 Ph: (601) 268-0400 |