Advanced Foot Clinic PLLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

80147 Issued in MS

Legal business name

ADVANCED FOOT CLINIC PLLC

Practice address

2475 Lakeland Dr
Suite B
Flowood, MS 39232-9505

Phone

(601) 936-3445

Fax

(601) 936-7434

NPI assigned

Feb 12, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Farzad Faryabi, DPMNPI 1649364860

Title

Owner

Phone

(601) 936-3445

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

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

• Farzad Faryabi, DPM

  • Podiatrist
  • Jackson, MS
  • NPI 1649364860
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388016000000",
    "number": "1275701294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 LAKELAND DR",
            "address_2": "SUITE B",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329505",
            "telephone_number": "601-936-3445",
            "fax_number": "601-936-7434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 LAKELAND DR",
            "address_2": "SUITE B",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329505",
            "telephone_number": "601-936-3445",
            "fax_number": "601-936-7434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2013-12-26",
        "status": "A",
        "authorized_official_last_name": "FARYABI",
        "authorized_official_first_name": "FARZAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-936-3445",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MS",
            "license": "80147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "427495756",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120443",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Adcock
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• Robyn Agnew, PHARM.D.
• Mohit Ahuja, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; 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.

Verify at the official NPI Registry.