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Organization
SOUTH SIDE FOOT CLINIC
Active
Organization
SOUTH SIDE FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICKIE KHANNA DPM (PRESIDENT)
(817) 923-1953
Entity
Organization
Contact information
Practice address
4759 SOUTH FWY STE B, FORT WORTH, TX 76115-3655
(817) 923-1953
(817) 923-9615
Mailing address
4759 SOUTH FWY STE B, FORT WORTH, TX 76115-3655
(817) 923-1953
(817) 923-9615
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
TX
Other
Enumeration date
06/24/2009
Last updated
06/24/2009
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