Organization
DELTA FOOT CLINICS, INC
Active
Other names
The Foot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN EDWARD SHOCKLEY DPM (PRESIDENT/OWNER)
(601) 638-7520
Entity
Organization
Contact information
Practice address
1814 MISSION 66, VICKSBURG, MS 39180-3710
(601) 638-7520
(601) 638-7541
Mailing address
1814 MISSION 66, VICKSBURG, MS 39180-3710
(601) 638-7520
(601) 638-7541
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
80142
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119033
—
MS
05
—
1540447
—
LA
01
—
1851563
UNITED HEALTHCARE
MS
01
—
412865
FIRST HEALTH
MS
01
—
430434140A
BCBS
MS
01
—
4342670001
MEDOCARE DME
MS
01
—
480026580
RAILROAD MEDICARE
MS
01
—
5963224
AETNA
MS
Enumeration date
01/30/2008
Last updated
01/28/2011
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