Organization
MISSISSIPPI FOOT AND SURGICAL CENTER, LLC
Active
Other names
Bryan T Sullivan
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN TIPTON SULLIVAN DPM (OWNER)
(601) 982-3338
Entity
Organization
Contact information
Practice address
1915 DUNBARTON DRIVE, JACKSON, MS 39216
(601) 982-3338
(601) 982-2253
Mailing address
1915 DUNBARTON DRIVE, JACKSON, MS 39216
(601) 982-3338
(601) 982-2253
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
80089
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00012910
—
MS
01
—
480007636
RAILROAD MEDICARE
—
Enumeration date
11/08/2006
Last updated
06/19/2008
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