Diabetic Shoe Source

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DIABETIC SHOE SOURCE

Practice address

104 McAuley Dr
Vicksburg, MS 39183-2825

Phone

(601) 883-3342

Fax

(601) 856-5955

NPI assigned

Jan 28, 2014

Last updated

Jan 28, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James T Phelan, DPM

Title

Owner

Phone

(601) 506-5689

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1396168290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MCAULEY DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832825",
            "telephone_number": "601-883-3342",
            "fax_number": "601-856-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MCAULEY DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832825",
            "telephone_number": "601-883-3342",
            "fax_number": "601-856-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETIC SHOE SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "PHELAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-506-5689",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Durable Medical Equipment & Medical Supplies in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.