Organization
SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION
Active
Parent organization
SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION
Other names
THE FOOT SURGERY CENTER OF SHREVEPORT
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHSIDE FOOT CLINIC OF SHREVEPORT INC A PROFESSIONAL CORPORATION
Authorized official
DR. RICHARD TAYLOR HAVENS DPM (ADMINISTRATOR/PHYSICIAN)
(318) 687-6266
Entity
Organization
Contact information
Practice address
9308 MANSFIELD RD, SUITE 300, SHREVEPORT, LA 71118-3134
(318) 687-6266
(318) 683-1023
Mailing address
9308 MANSFIELD RD, SUITE 300, SHREVEPORT, LA 71118-3134
(318) 687-6266
(318) 683-1023
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
33
LA
Other
Enumeration date
12/07/2005
Last updated
12/29/2025
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