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Organization
SOUTH SIDE FOOT CLINIC INC.
Active
Organization
SOUTH SIDE FOOT CLINIC INC.
Active
Other names
South Side Med Ex
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICKIE KHANNA (SECRETARY)
(817) 923-1953
Entity
Organization
Contact information
Practice address
4759 SOUTH FWY, SUITE B, FORT WORTH, TX 76115-3655
(817) 923-1953
(817) 923-9615
Mailing address
4759 SOUTH FWY, SUITE B, FORT WORTH, TX 76115-3655
(817) 923-1953
(817) 923-9615
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186646901
—
TX
Enumeration date
01/23/2007
Last updated
10/10/2013
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