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SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION , NPI 1033111240

Podiatrist in SHREVEPORT, LA

Last Updated on : Sep 11,2013

About SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION (NPI 1033111240)


SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION is a Podiatrist in SHREVEPORT, United States with a focus in Foot & Ankle Surgery.

1033111240 is NPI number of SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION.

SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION's primary taxonomy code based on NPI Lookup is 213ES0103X with license number 5B496. This taxonomy code refers to Podiatrist.

SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION current practice location address is 9308 MANSFIELD RD, SHREVEPORT, LA. SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION can be reached out via phone at 318-687-6266 and via fax at 318-683-1023 .

You can also correspond with SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION through mail at mailing address 9308 MANSFIELD RD, SHREVEPORT, LA, United States. Mailing address contact number is 318-687-6266.

The enumeration date of SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION is 01-Jun-2005. The provider is registered as an Organization and the NPI record was last updated 9 years ago.

The authorized official of SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION is RICHARD HAVENS (PHYSICIAN/ADMINISTRATOR). RICHARD HAVENS can be reached at 3186876266.

1033111240 NPI Information

Name SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION
National Provider Id (NPI) 1033111240
Entity Type Organization
Practice Address 9308 MANSFIELD RD, STE 100
SHREVEPORT, LA, United States
Practice Telephone 318-687-6266
Practice Fax Number 318-683-1023
Mailing Address 9308 MANSFIELD RD , STE 100
SHREVEPORT, LA, United States
Mailing Telephone 318-687-6266
Mailing Fax Number 318-683-1023
Enumeration Date 01-Jun-2005
Last Updated Date 11-Sep-2013

SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION (NPI 1033111240) Primary Taxonomy Information

Primary Taxonomy Code Clasification License Number License State
Y 213ES0103X Podiatrist, Foot & Ankle Surgery 5B496 LA

Additional Identifiers

Identifier Type/Code Identifier State Identifier Issuer
0691670001 MEDICARE NSC (07) LA
T19684 MEDICARE UPIN (02) LA
U22022 MEDICARE UPIN (02) LA

SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION (NPI 1033111240) Office Location

Providers in same location

NPI Name Taxonomy Address Enumeration date
1053403659 JORGE MARTINEZ-LEYVA, MD Neurological Surgery 8001 YOUREE DRIVE, SUITE 850
SHREVEPORT, AL, United States
29-Sep-2006
1780191643 BRIANA MARIE DAVIS Technician, Attendant Care Provider 6055 FOX CHASE TRL,
SHREVEPORT, LA, United States
01-Jan-2018
1851930374 TONI L WILLIAMS Case Manager/Care Coordinator 5821 WESTRAY DR,
SHREVEPORT, LA, United States
01-Jan-2020
1669060034 JERRY LLOYD WILLIFORD Nurse Practitioner PO BOX 4506,
SHREVEPORT, LA, United States
01-Jan-2021
1902963929 SHANNON BURTON PECK Psychologist, Clinical 510 E STONER AVE,
SHREVEPORT, LA, United States
02-Jan-2007
1275690125 COMMCARE LOUISIANA Durable Medical Equipment & Medical Supplies 5201A SHREVEPORT HIGHWAY,
PINEVILLE, LA, United States
02-Jan-2007
1215094040 PATRICK TIMOTHY GALLAGHER Emergency Medicine 2049 PEPPER RIDGE DR,
SHREVEPORT, LA, United States
02-Jan-2007
1427115153 SPENCER HEATH LOVITT Specialist 9432 KROETZ DR,
SHREVEPORT, LA, United States
02-Jan-2007
1750685954 GREGORY BRIGOLA Chiropractor 4626 S CLYDE MORRIS BLVD STE 1,
PORT ORANGE, FL, United States
02-Jan-2011
1972924363 BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA Pharmacy, Nuclear Pharmacy PO BOX 38050,
SHREVEPORT, LA, United States
02-Jan-2014
1578008421 CANDACE BRACY Counselor, Mental Health 3501 CHAMPION LAKE BLVD, APT 401
SHREVEPORT, LA, United States
02-Jan-2017
1891202776 ALLCARE OF LOUISIANA, INC. Community/Behavioral Health 4615 MONKHOUSE DR STE 116,
SHREVEPORT, LA, United States
02-Jan-2018
1194232959 AVIANCE SHANTEL SMITH Counselor, Mental Health 9403 MANSFIELD RD,
SHREVEPORT, LA, United States
02-Jan-2018
1801369897 KENYA SHANTELL MAESHACK Case Manager/Care Coordinator 8120 CARDIGAN WAY,
SHREVEPORT, LA, United States
02-Jan-2019
1184197188 LAQUEISHA NAQUAE WILLIAMS Specialist/Technologist, Athletic Trainer 3406 RIVIERA ST,
SHREVEPORT, LA, United States
02-Jan-2019
1013556455 ARNIESHA D KEENER Case Manager/Care Coordinator 9403 MANSFIELD RD,
SHREVEPORT, LA, United States
02-Jan-2020
1386232775 TIFFANY CARR Registered Nurse, Critical Care Medicine 9030 NEWCASTLE DR,
SHREVEPORT, LA, United States
02-Jan-2021
1245991355 KESHANA DOMINIQUE Homemaker 9278 REUNION DR,
SHREVEPORT, LA, United States
02-Jan-2022
1114688132 TYRHONDA L WOODARD Home Health Aide 3126 BERT KOUNS INDUSTRIAL LOOP APT 274,
SHREVEPORT, LA, United States
02-Jan-2022
1871571778 WELLNECESSITIES ,INC. Clinic/Center, Sleep Disorder Diagnostic 8835 LINE AVENUE, SUITE 500
SHREVEPORT, LA, United States
03-Jan-2006

FAQs

Whose NPI Number is 1033111240?

1033111240 is the NPI number of SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION.

Where is SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION located?

SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION is located at 9308 MANSFIELD RD, SHREVEPORT, LA.

NPI number meaning

Field Name Field Value
NPI 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address The mailing address of the provider being identified contains First line, Second Line, City name, State name, Postal code, and Country code.
Provider Business Mailing Address Telephone Number The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider Business Practice Location Address Telephone Number The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number The fax number associated with the location address of the provider being identified.
Provider Enumeration Date The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date The date that a record was last updated or changed.
Authorized Official Telephone Number The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy Taxonomy Description of the Healthcare Provider.
Provider License Number Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
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