Provider Demographics
NPI:1871953877
Name:FOOT AND SURGERY CLINCI, INC
Entity type:Organization
Organization Name:FOOT AND SURGERY CLINCI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERSHERN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-3222
Mailing Address - Street 1:7402 S SIWELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9386
Mailing Address - Country:US
Mailing Address - Phone:601-372-3222
Mailing Address - Fax:
Practice Address - Street 1:580 S PEAR ORCHARD RD APT 312
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4210
Practice Address - Country:US
Practice Address - Phone:601-212-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80112213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty