Southside Foot Clinic P C
Organization Active NPI Podiatrist · Greenwood, IN
NPI 1528117553 · NPPES record last updated Feb 4, 2008
Key facts
- NPI
- 1528117553
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- 07000316 (IN)
- Legal business name
- SOUTHSIDE FOOT CLINIC P C
- Practice address
- 33 E County Line Rd Ste B
Greenwood, IN 46143-1043 - Phone
- (317) 882-9303
- Fax
- (317) 882-6605
- NPI assigned
- Jan 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. J Karl Winckelbach, DPM
- Title
- Podiatrist
- Phone
- (317) 882-9303
Practitioners 3
-
Kathryn Alleva, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080108000149 | IN | Part B Supplier - Clinic/Group Practice | 7113007899 |
Receives reassigned benefits from 2 practitioners Practice locations: Greenwood, IN |
| O20100930047567 | IN | DME Supplier - Physician - Podiatry | 7113007899 | Practice locations: Greenwood, IN |
National Provider Directory
Locations
33 E County Line Rd
Ste B
Greenwood, IN 46143
Phone (317) 690-8901
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | 07000316 | IN | Yes |
| Foot & Ankle Surgery Podiatrist |
213ES0103X | 07000316 | IN | |
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
33 E County Line Rd Ste B
Greenwood, IN 46143-1043
Mailing address
33 E County Line Rd Ste B
Greenwood, IN 46143-1043
Phone (317) 882-9303
Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.