NPIMap

Organization Active NPI

John D Wise III

Doing business as Comfortwise Footwear

  • Durable Medical Equipment & Medical Supplies
  • Clinton, MS
National Provider Identifier
1972538460
Registry record updated Nov 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
JOHN D WISE III
Doing business as
Comfortwise Footwear
Practice address
600 E Northside Dr
Suite D
Clinton, MS 39056-3437
Phone
(601) 925-9473
Fax
(601) 925-9490
NPI assigned
Jul 12, 2006
Last updated
Nov 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2010

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

Authorized official

Name
Mr. John Durr Wise III, C. PED.NPI 1346543345
Title
Principal
Phone
(601) 925-9473

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MS Primary

Addresses

Primary practice location

600 E Northside Dr
Suite D
Clinton, MS 39056-3437

Mailing address

600 E Northside Dr
Suite D
Clinton, MS 39056-3437
Phone (601) 925-9473

Other identifiers 1

IdentifierTypeStateIssuer
02053764MedicaidMS

Other names 1

  • Comfortwise Footwear Doing business as

National Provider Directory

National Provider Directory

Locations

600 E Northside Dr
Ste D
Clinton, MS 39056
Phone (601) 925-9473

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289260800000",
    "number": "1972538460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E NORTHSIDE DR",
            "address_2": "SUITE D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563437",
            "telephone_number": "601-925-9473",
            "fax_number": "601-925-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E NORTHSIDE DR",
            "address_2": "SUITE D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563437",
            "telephone_number": "601-925-9473",
            "fax_number": "601-925-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D WISE III",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2010-11-09",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DURR",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "601-925-9473",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "C. PED."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02053764",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfortwise Footwear",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; 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.