Southern Podiatry Foot and Ankle, PLLC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

299 Issued in AL

Legal business name

SOUTHERN PODIATRY FOOT AND ANKLE, PLLC

Practice address

8000 Madison Blvd Ste D102-341
Madison, AL 35758-2031

Phone

(312) 752-7713

NPI assigned

Jul 13, 2009

Last updated

Dec 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elyse N Tiller

Title

CPCS

Phone

(615) 956-7919

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, TN2 enrollments

Enrollment records 2

Tax ID family

Southern Podiatry Foot and Ankle LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Southern Podiatry Foot and Ankle LLC

  • Podiatrist
  • Homer, GA
  • NPI 1619112968
  NPD tax ID

Locations

Practitioners 1

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.

• Rick Thornton, DPM

  • Podiatrist
  • Huntsville, AL
  • NPI 1518162858

  TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1497984397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 GRANDEVIEW BLVD APT 1928",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358242408",
            "telephone_number": "312-752-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 MADISON BLVD STE D102-341",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582031",
            "telephone_number": "312-752-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PODIATRY FOOT AND ANKLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "TILLER",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CPCS",
        "authorized_official_telephone_number": "615-956-7919"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "AL",
            "license": "299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeastern Podiatry LLC
• Southeastern Skin Cancer & Dermatology
• Southern Care Physical Therapy, LLC
• Southern Elevator Service, Inc.
• Southern Family Markets LLC (Southern Family Market)
• Jenny Southwood, CRNP
• Breana Lynn Spain, FNP-C
• Lisa J Spears, LMT
• Speech Therapy Solutions
• Speechtime, Inc

• Foot Surgery Podiatrist in Madison, AL
• Providers in Madison, AL by specialty
• Foot Surgery Podiatrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.