Advanced Foot Care Center

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

80152 Issued in MS

Legal business name

ADVANCED FOOT CARE CENTER

Practice address

4510 Office Park Dr
Jackson, MS 39206-6016

Phone

(601) 981-3001

Fax

(601) 981-8999

NPI assigned

Jun 4, 2007

Last updated

Aug 19, 2008By 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

Dr. Larry R Cruel, DPM

Title

Podiatrist Owner

Phone

(601) 981-3001

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Larry K Cruel, DPM

  • Primary Podiatric Medicine Podiatrist
  • Jackson, MS
  • NPI 1609996982
  NPD (past)

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1497957120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 OFFICE PARK DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392066016",
            "telephone_number": "601-981-3001",
            "fax_number": "601-981-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 OFFICE PARK DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392066016",
            "telephone_number": "601-981-3001",
            "fax_number": "601-981-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "CRUEL",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PODIATRIST OWNER",
        "authorized_official_telephone_number": "601-981-3001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MS",
            "license": "80152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09274794",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Podiatric Medicine Podiatrist in Jackson, MS
• Providers in Jackson, MS by specialty
• Primary Podiatric Medicine Podiatrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.