Mississippi Foot and Surgical Center, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

80089 Issued in MS

Legal business name

MISSISSIPPI FOOT AND SURGICAL CENTER, LLC

Practice address

1915 Dunbarton Drive
Jackson, MS 39216

Phone

(601) 982-3338

Fax

(601) 982-2253

NPI assigned

Nov 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bryan Tipton Sullivan, DPMNPI 1164592044

Title

Owner

Phone

(601) 982-3338

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bryan T Sullivan Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Tipton Sullivan, DPM

  • Podiatrist
  • Jackson, MS
  • NPI 1164592044
  NPD (past) Authorized official
• Johnny C Wright, M.D., D.P.M.

  • Family Medicine Physician
  • Windsor, CT
  • NPI 1952455370
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1235209115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 DUNBARTON DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-982-3338",
            "fax_number": "601-982-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 DUNBARTON DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-982-3338",
            "fax_number": "601-982-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI FOOT AND SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "TIPTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-982-3338",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MS",
            "license": "80089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00012910",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480007636",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryan T Sullivan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mississippi Em-I Medical Services PC
• Mississippi Emergency Physician Services, LLC
• Mississippi Eye Care Associates of Jackson, PLLC
• Mississippi Eyecare Associates of Jackson, PLLC.
• Mississippi Families for Kids
• Mississippi Foot Clinic, Inc
• Mississippi Health Services, LLC
• Mississippi Hearing Center, Inc
• Mississippi Hma Hospitalists, LLC
• Mississippi Hma Hospitalists, LLC

• Podiatrist in Jackson, MS
• Providers in Jackson, MS by specialty
• Podiatrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.