Diabetic Shoe Source
NPI #1396168290 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1396168290
- Entity Type
- Organization
- Organization Name
- Diabetic Shoe Source
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- Jan 28, 2014
- Last Updated
- Jan 28, 2014
Practice Location
- Address
- 104 MCAULEY DR
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39183-2825
- Phone
- (601) 883-3342
Authorized Official
- Name
- JAMES T PHELAN, DPM
- Title
- OWNER
- Phone
- (601) 506-5689
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
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