| Organization Name: | JLA SENIOR FOOTCARE MS LLC |
| NPI Number: | 1508161597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY INNOCENZI (OWNER) |
| Mailing Address: | 300 Ark Ln Petal |
| State: | MS US |
| Postal Code: | 394653606 |
| Phone Number: | 3307020978 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2011 |
| NPI Last Update Date: | 01/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 80205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |