DELTA FOOT CLINICS, INC (NPI# 1962689042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962689042 |
| Entity Type | Organization |
| Organization Name | DELTA FOOT CLINICS, INC |
| Other Organization Name | THE FOOT CLINIC |
| Practice Address |
1814 Mission 66 Vicksburg MS 39180-3710 |
| Practice Telephone | 6016387520 |
| Practice Fax Number | 6016387541 |
| Mailing Telephone | 6016387520 |
| Mailing Fax Number | 6016387541 |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2011-01-28 |
| Authorized Official Name | DR. BRIAN EDWARD SHOCKLEY (PRESIDENT/OWNER) |
| Authorized Official Telephone | 6016387520 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP1100X |
Clinic/Center Specialization: Podiatric |
80142 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1540447 | 05 | |
| MS | UNITED HEALTHCARE | 1851563 | 01 |
| MS | 00119033 | 05 | |
| MS | FIRST HEALTH | 412865 | 01 |
| MS | AETNA | 5963224 | 01 |
| MS | BCBS | 430434140A | 01 |
| MS | MEDOCARE DME | 4342670001 | 01 |
| MS | RAILROAD MEDICARE | 480026580 | 01 |
| Other Name | Type Code |
|---|---|
| The Foot Clinic | Doing Business As Name - Organization |
| Street Address |
1814 MISSION 66 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-3710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477662229 | Brian Edward Shockley | Podiatrist | 1814 Mission 66, Vicksburg, MS 39180-3710 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 261QP1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Podiatric |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245849009 | Southern Michigan Foot & Ankle, Plc | Clinic/Center | 14167 C B Macdonald Way, Vicksburg, MI 49097-8397 | 2020-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316585003 | Cohen Podiatry Clinic | Clinic/Center | 905 Hardy St, Hattiesburg, MS 39401-4163 | 2019-12-13 |
| 1447429089 | Foot and Wound Institute of The South | Clinic/Center | 157 Fe Sellers Highway, Monticello, MS 39654 | 2008-02-28 |
| 1073557799 | Prime Foot Care, Pllc | Clinic/Center | 9065 Sandidge Center Cove, Ste C, Olive Branch, MS 38654-3574 | 2006-06-15 |
| 1942848635 | Cohen Podiatry Clinic | Clinic/Center | 136 S 15th Ave, Laurel, MS 39440-4124 | 2019-12-13 |
| 1346888096 | Cohen Podiatry Clinics | Clinic/Center | 7530 Highway 57, Vancleave, MS 39565-6512 | 2019-12-12 |
| 1063865343 | Wjl Podiatry Clinic LLC | Clinic/Center | 953 North St, Jackson, MS 39202-2615 | 2016-07-21 |
| 1831376508 | Cohen Podiatry Clinics | Clinic/Center | 12056 Mobile Ave, Gulfport, MS 39503-3004 | 2008-01-24 |
Please comment or provide details below to improve the information on DELTA FOOT CLINICS, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.