# SOUTH SIDE FOOT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700014214
- **Authorized official:** DR. VICKIE KHANNA DPM (PRESIDENT)
- **Authorized official phone:** (817) 923-1953

## Contact information

- **Practice address:** 4759 SOUTH FWY STE B, FORT WORTH, TX 76115-3655
- **Practice address phone:** (817) 923-1953
- **Practice address fax:** (817) 923-9615
- **Mailing address:** 4759 SOUTH FWY STE B, FORT WORTH, TX 76115-3655
- **Mailing address phone:** (817) 923-1953
- **Mailing address fax:** (817) 923-9615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | TX | Yes |

## Other

- **Enumeration date:** 06/24/2009
- **Last updated:** 06/24/2009