Organization
LA MISS DIABETIC SHOES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE F PHELAN DPM (OWNER/PROVIDER)
(601) 883-3342
Entity
Organization
Contact information
Practice address
2200 HIGHWAY 61 N, SUITE 3400, VICKSBURG, MS 39183-8246
(601) 883-3342
(601) 856-5955
Mailing address
139 SOUTHERN RIDGE DR, MADISON, MS 39110-9484
(601) 883-3342
(601) 856-5955
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
80145
MS
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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