SOUTH SIDE FOOT CLINIC NPI 1700014214

NPI Information

SOUTH SIDE FOOT CLINIC is a durable medical equipment medical supplies in Fort Worth, TX. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. SOUTH SIDE FOOT CLINIC NPI is 1700014214. The provider is registered as an organization entity type.

The provider's business location address is:

4759 SOUTH FWY STE B
FORT WORTH, TX
ZIP 76115-655
Phone: (817) 923-1953
Fax: (817) 923-9615

The provider's authorized official is Vickie Khanna .
The authorized official title is President and has the following contact phone number (817) 923-1953.

The CLIA number assigned to this NPI record is 45D0920264 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/24/2009 and was last updated on 6/24/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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