South Side Foot Clinic Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

SOUTH SIDE FOOT CLINIC INC.

Practice address

4759 South Fwy
Suite B
Fort Worth, TX 76115-3655

Phone

(817) 923-1953

Fax

(817) 923-9615

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Vickie Khanna

Title

Secretary

Phone

(817) 923-1953

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Side Med Ex Doing business as

Locations

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1205980232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4759 SOUTH FWY",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761153655",
            "telephone_number": "817-923-1953",
            "fax_number": "817-923-9615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4759 SOUTH FWY",
            "address_2": "SUITE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761153655",
            "telephone_number": "817-923-1953",
            "fax_number": "817-923-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE FOOT CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "KHANNA",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "817-923-1953",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186646901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Side Med Ex",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sound Mind Holistic Services LLC
• Sound Physicians Anesthesiology of Texas PLLC
• South Eyeworks Group, Inc
• South Script Health Care Inc
• South Side Foot Clinic
• South Texas Dental Associates, L.P.
• South Texas Dental Associates, L.P.
• South Texas Dental Associates, L.P.
• South Texas Dental Associates, LP
• South Texas Dental Associates, LP

• Podiatrist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.