Southside Foot Clinic of Shreveport Inc a Professional Corporation

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

33 Issued in LA

Legal business name

SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION

Doing business as

The Foot Surgery Center of Shreveport

Practice address

9308 Mansfield Rd
Suite 300
Shreveport, LA 71118-3134

Phone

(318) 687-6266

Fax

(318) 683-1023

NPI assigned

Dec 7, 2005

Last updated

Dec 29, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATIONAs reported in NPPES

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

Authorized official

Name

Dr. Richard Taylor Havens, DPMNPI 1285643908

Title

Administrator/Physician

Phone

(318) 687-6266

Specialties & licenses 1

Addresses

Other names 1

• THE FOOT SURGERY CENTER OF SHREVEPORT Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southside Foot Clinic of Shreveport, Inc. a Professional Corporation

  dba Southside Foot Clinic

  • Foot & Ankle Surgery Podiatrist
  • Shreveport, LA
  • NPI 1033111240

  3971547316

  Same PAC ID

Listed as

The Foot Surgery Ctr of ShreveportCCN 19C0001026

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Southside Foot Clinic of Shreveport Inc a Professional Corporation2 organizations share this tax ID, including this one

Part of

Southside Foot Clinic of Shreveport Inc a Professional Corporation

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southside Foot Clinic of Shreveport, Inc. a Professional Corporation

  dba Southside Foot Clinic

  • Foot & Ankle Surgery Podiatrist
  • Shreveport, LA
  • NPI 1033111240
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Southside Foot Clinic of Shreveport, Inc. a Professional Corporation

  dba Southside Foot Clinic

  • Foot & Ankle Surgery Podiatrist
  • Shreveport, LA
  • NPI 1033111240
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Taylor Havens, DPM

  • Podiatrist
  • Shreveport, LA
  • NPI 1285643908
  NPD Authorized official
• Stephen Eugene Ertz, DPM

  • Podiatrist
  • Shreveport, LA
  • NPI 1356321681
  NPD

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1245215706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9308 MANSFIELD RD",
            "address_2": "SUITE 300",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183134",
            "telephone_number": "318-687-6266",
            "fax_number": "318-683-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9308 MANSFIELD RD",
            "address_2": "SUITE 300",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183134",
            "telephone_number": "318-687-6266",
            "fax_number": "318-683-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION",
        "enumeration_date": "2005-12-07",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A",
        "authorized_official_last_name": "HAVENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "ADMINISTRATOR/PHYSICIAN",
        "authorized_official_telephone_number": "318-687-6266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "LA",
            "license": "33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE FOOT SURGERY CENTER OF SHREVEPORT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Southside Foot Clinic of Shreveport, Inc. a Professional Corporation (Southside Foot Clinic)
• Skylar Amanda Souyoul, M.D.
• Kevin Thomas Sowell, PHYSICAL THERAPIST
• Alison Smith Spann, MD
• Marilyn Sparks

• Ambulatory Surgical Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Ambulatory Surgical Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.