NPIMap

Organization Active NPI

Mid-South Foot and Ankle Specialists, PLLC

  • Foot & Ankle Surgery Podiatrist
  • Cordova, TN
National Provider Identifier
1467547588
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
MID-SOUTH FOOT AND ANKLE SPECIALISTS, PLLC
Practice address
8055 Club Pkwy
Cordova, TN 38016-5967
Phone
(901) 309-7700
Fax
(901) 507-3297
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Authorized official

Name
Chad E Webster, DPMNPI 1144220666
Title
Chief Officer
Phone
(901) 309-7700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

8055 Club Pkwy
Cordova, TN 38016-5967

Mailing address

8055 Club Pkwy
Cordova, TN 38016-5967
Phone (901) 309-7700

Other identifiers 1

IdentifierTypeStateIssuer
3353819MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040504000101 TN Part B Supplier - Clinic/Group Practice 5597753046 Receives reassigned benefits from 7 practitioners
Practice locations: Cordova, TN
O20100930060450 TN DME Supplier - Physician - Podiatry 5597753046 Practice locations: Cordova, TN

National Provider Directory

National Provider Directory
Tax ID family
Midsouth Foot and Ankle5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

76 Capital Way
Atoka, TN 38004

8200 Old Dexter Rd
Ste 106
Cordova, TN 38016
Phone (901) 309-7700

6041 Poplar Ave 190
Memphis, TN 38119

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1467547588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8055 CLUB PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165967",
            "telephone_number": "901-309-7700",
            "fax_number": "901-507-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8055 CLUB PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165967",
            "telephone_number": "901-309-7700",
            "fax_number": "901-507-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH FOOT AND ANKLE SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF OFFICER",
        "authorized_official_telephone_number": "901-309-7700",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3353819",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.