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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