JLA SENIOR FOOTCARE MS LLC (NPI# 1508161597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508161597 |
| Entity Type | Organization |
| Organization Name | JLA SENIOR FOOTCARE MS LLC |
| Practice Address |
300 Ark Ln Petal MS 39465-3606 |
| Mailing Address |
4870 S Aspen Ct Canfield OH 44406-8469 |
| Practice Telephone | 3307020978 |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |
| Authorized Official Name | ANTHONY INNOCENZI (OWNER) |
| Authorized Official Telephone | 3307020978 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
80205 | MS | Podiatric Medicine & Surgery Service Providers |
| Street Address |
300 ARK LN |
| City | PETAL |
| State | MS |
| Zip Code | 39465-3606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164055489 | R&p Elite Services, LLC | Private Vehicle | 68 Springfield Rd., Petal, MS 39465 | 2020-02-14 |
| 1003460544 | Hayden White | Pharmacist | 36 Byrd Dr., Petal, MS 39465 | 2019-08-01 |
| 1134612971 | Chandler Mccarley Hawkins | Dentist | 1115 Evelyn Gandy Parkway, Petal, MS 39465 | 2018-06-06 |
| 1881199818 | Lauren O'neal Garner | Nurse Practitioner | 36 Stadium Drive, Petal, MS 39465 | 2018-03-30 |
| 1700036928 | Petal School District | Registered Nurse | 60 Herrington Road, Petal, MS 39465 | 2008-09-24 |
| 1962679043 | Hattiesburg Eye Clinic Pa | Optometrist | 1223 Hwy 42, Ste 140, Petal, MS 39465 | 2008-05-08 |
| 1023228640 | Noal Baxter Cochran | Marriage & Family Therapist | 80 Lakeland Circle, Petal, MS 39465 | 2007-05-23 |
| 1750596938 | James A Nicholson Dds Pa | Dentist | 120 South 28th Avenue, Hattiesburg, MS 39465 | 2007-05-11 |
| 1356563605 | Petal School District | Registered Nurse | 400 Hillcrest Loop, Petal, MS 39465 | 2007-05-03 |
| 1154480804 | Mary E Thomsen | Orthotic Fitter | 173 Cherry Oak Trail, Petal, MS 39465 | 2006-12-08 |
| Find all providers in zip 39465 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780218289 | Ortho Express Holding Company, LLC | Podiatrist | 3952 N Gloster St Ste C, Tupelo, MS 38804-0913 | 2020-02-24 |
| 1124479100 | Foot and Surgery Clinic, Inc | Podiatrist | 7402 S Siwell Rd, Suite 110, Byram, MS 39272-9386 | 2016-06-30 |
| 1871953877 | Foot and Surgery Clinci, Inc | Podiatrist | 580 S Pear Orchard Rd Apt 312, Ridgeland, MS 39157-4210 | 2016-03-03 |
| 1497905079 | Vershern Edwards | Podiatrist | 297 Hwy 51 Suite C, Ridgeland, MS 39157 | 2008-09-19 |
| 1285827071 | Moss Point Foot Clinic, LLC | Podiatrist | 4316 Mcinnis Ave, Moss Point, MS 39563-2812 | 2007-08-24 |
| 1821208372 | Natchez Podiatry & Foot Surgery Pa | Podiatrist | 228c John R Junkin Dr, Natchez, MS 39120-3822 | 2007-05-23 |
| 1205049657 | Michael L Boykins | Podiatrist | 6800 Old Canton Rd Ste 111, Ridgeland, MS 39157-1254 | 2007-05-08 |
| 1407922867 | Scott Joseph Hanegan | Podiatrist | 1300 25th Ave, Meridian, MS 39301-3916 | 2006-11-28 |
| 1336220177 | Robert Kelvin Woodruff | Podiatrist | 3855 Azalea Drive, Jackson, MS 39206-5105 | 2006-10-18 |
| 1669575668 | Michael Frank De Marco | Podiatrist | 101 Lamar Smith Rd, Poplarville, MS 39470 | 2006-09-06 |
| 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.