Active NPI
Foot and Surgery Clinic, Inc
- Foot Surgery Podiatrist
- Byram, MS
National Provider Identifier
1124479100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- 80112
- Legal business name
- FOOT AND SURGERY CLINIC, INC
- Practice address
- 7402 S Siwell Rd
Suite 110
Byram, MS 39272-9386 - Phone
- (601) 372-3222
- NPI assigned
- Jun 30, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Versheen Edwards, D.P.M
- Title
- President
- Phone
- (601) 372-3222
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | 80112 | MS | Primary |
Addresses
Primary practice location
7402 S Siwell Rd
Suite 110
Byram, MS 39272-9386
Mailing address
7402 S Siwell Rd
Suite 110
Byram, MS 39272-9386
Phone (601) 372-3222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00111109 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS, TX
Enrollment records 2
National Provider Directory
National Provider Directory- Tax ID family
- Foot and Surgery Clinic Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Foot Surgery Podiatrist
- Ridgeland, MS
- NPI 1871953877
Locations
5701 Highway 80 W
Jackson, MS 39209
Phone (601) 316-7559
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1503273600000",
"number": "1124479100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7402 S SIWELL RD",
"address_2": "SUITE 110",
"city": "BYRAM",
"state": "MS",
"postal_code": "392729386",
"telephone_number": "601-372-3222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7402 S SIWELL RD",
"address_2": "SUITE 110",
"city": "BYRAM",
"state": "MS",
"postal_code": "392729386",
"telephone_number": "601-372-3222"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOOT AND SURGERY CLINIC, INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-06-30",
"last_updated": "2017-08-21",
"status": "A",
"authorized_official_last_name": "EDWARDS",
"authorized_official_first_name": "VERSHEEN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "601-372-3222",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.P.M"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot Surgery",
"state": "MS",
"license": "80112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00111109",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Byram, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.