Delta Foot Clinics, Inc

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

80142 Issued in MS

Legal business name

DELTA FOOT CLINICS, INC

Doing business as

The Foot Clinic

Practice address

1814 Mission 66
Vicksburg, MS 39180-3710

Phone

(601) 638-7520

Fax

(601) 638-7541

NPI assigned

Jan 30, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Brian Edward Shockley, DPMNPI 1477662229

Title

President/Owner

Phone

(601) 638-7520

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• The Foot Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Locations

Practitioners 2

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

• Brian Edward Shockley, D P M

  • Podiatrist
  • Vicksburg, MS
  • NPI 1477662229
  Medicare reassignment NPD Authorized official
• Tuyen Thi Hoang, DPM

  • Primary Podiatric Medicine Podiatrist
  • Garland, TX
  • NPI 1508883091
  NPD (past)

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1962689042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803710",
            "telephone_number": "601-638-7520",
            "fax_number": "601-638-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803710",
            "telephone_number": "601-638-7520",
            "fax_number": "601-638-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA FOOT CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "601-638-7520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "MS",
            "license": "80142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDOCARE DME",
            "identifier": "4342670001",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1851563",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119033",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "430434140A",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5963224",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1540447",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480026580",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "412865",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherita Davis
• Donald Allan Dearman, NURSE PRACTITIONER
• Jennifer Decker
• Megann Price Dees, PA-C
• Jessica Delk
• Delta Orthodontic Specialists LLC
• Delta Orthodontic Specialists, LLC
• Denesia Y Giffin PLLC
• Rhonda C Denman, LMFT
• Georgia Dent, HAIR LOSS SPECIALIST

• Podiatric Clinic/Center in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Podiatric Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; 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.