ROBERT CROCKETT ENTERPRISE LLC (NPI# 1114201423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114201423 |
| Entity Type | Organization |
| Organization Name | ROBERT CROCKETT ENTERPRISE LLC |
| Other Organization Name | MAGNOLIA DME |
| Practice Address |
2310 4th St Suite A Meridian MS 39301-5819 |
| Practice Telephone | 6012863745 |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |
| Authorized Official Name | DR. ROBERT S CROCKETT (MEMBER) |
| Authorized Official Telephone | 6012863745 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
80193 | MS | Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| Magnolia DME | Doing Business As Name - Organization |
| Street Address |
2310 4TH ST SUITE A |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301-5819 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699070326 | Magnolia Foot Clinic LLC | Podiatrist | 2310 4th St, Suite A, Meridian, MS 39301-5819 | 2011-01-11 |
| 1710288873 | Jacquelyn Marie Hunter-moore | Dentist | 2310 4th St, Ste. B, Meridian, MS 39301-5819 | 2010-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518225929 | Clark A Johnson | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2012-04-24 |
| 1396023446 | Kurt Earl Kinghorn | Podiatrist | 1828 S Millenium Way Ste 200, Meridian, ID 83642-5036 | 2011-07-22 |
| 1083261697 | Treasure Valley Foot and Ankle | Podiatrist | 3120 W Belltower Dr Ste 100, Meridian, ID 83646-7744 | 2019-08-20 |
| 1699070326 | Magnolia Foot Clinic LLC | Podiatrist | 2310 4th St, Suite A, Meridian, MS 39301-5819 | 2011-01-11 |
| 1710924345 | Clinton H Clark | Podiatrist | 520 S Eagle Rd, Ste 1243, Meridian, ID 83642-6351 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851913842 | Premier Podiatry LLC | Podiatrist | 5434 River Thames Rd, Jackson, MS 39211-4133 | 2020-05-12 |
| 1396085015 | Marion Shaun Lund | Podiatrist | 1194 S 18th Street Ext, Oxford, MS 38655-5378 | 2013-02-15 |
| 1942525738 | Jeffery John Vanyperen Jr. | Podiatrist | 1107 Earl Frye Blvd Ste 1, Amory, MS 38821-5519 | 2010-04-05 |
| 1982939773 | Frank Eldridge Evans | Podiatrist | 2512 25th Ave, Hwy 49 Suite 3, Gulfport, MS 39501-4814 | 2009-10-12 |
| 1942463567 | Stanitia W. Davis | Podiatrist | 953 North St, Suite A, Jackson, MS 39202-2615 | 2008-07-03 |
| 1275732596 | Bernard J Meadows Jr. | Podiatrist | 1720a Medical Park Dr Ste 220, Biloxi, MS 39532-2127 | 2007-07-17 |
| 1194805457 | James Terence Phelan | Podiatrist | 587 Highway 51 Ste T2, Ridgeland, MS 39157-2506 | 2006-10-17 |
| 1720171002 | Joann Orphanos | Podiatrist | 15095 Dedeaux Road, Gulfport, MS 39503-3284 | 2006-10-01 |
| 1912273814 | Davis Podiatry, LLC | Podiatrist | 128 Poindexter St, Jackson, MS 39203-3048 | 2012-03-26 |
| 1578884466 | Ashley Dawn Blackwell | Podiatrist | 705 Highway 80 W, Clinton, MS 39056-4103 | 2010-06-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.