| Southside Foot Clinic | |
|
9308 Mansfield Rd, Ste 100, Shreveport, LA 71118-3134 | |
| (318) 687-6266 | |
| (318) 683-1023 |
| Full Name | Southside Foot Clinic |
|---|---|
| Type | Facility |
| Speciality | Podiatrist - Foot & Ankle Surgery |
| Location | 9308 Mansfield Rd, Shreveport, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033111240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 5B496 (Louisiana) | Primary |
| Provider Name | Stephen E Ertz |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1356321681 PECOS PAC ID: 4880638220 Enrollment ID: I20120105000973 |
| Provider Name | Richard T Havens |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1285643908 PECOS PAC ID: 0547375602 Enrollment ID: I20120127000457 |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Foot Clinic 9308 Mansfield Rd, Ste 100, Shreveport, LA 71118-3134 Ph: (318) 687-6266 | Southside Foot Clinic 9308 Mansfield Rd, Ste 100, Shreveport, LA 71118-3134 Ph: (318) 687-6266 |
Dr. Alaye Eldred Whyte, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1718 Kings Hwy, Shreveport, LA 71103 Phone: 318-636-2669 Fax: 318-636-2663 | |
Dr. Frederick Jacques Hall, D.P.M. Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 510 E Stoner Ave, Shreveport, LA 71101 Phone: 678-640-5685 | |
Dr. Dale Carlton Fazio, D.P.M. Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1914 E 70th St, Suite D, Shreveport, LA 71105 Phone: 318-797-3470 Fax: 318-797-9956 | |
Evetta Lavern Borden, DPM Podiatrist Medicare: Medicare Enrolled Practice Location: 510 E Stoner Ave, Shreveport, LA 71101 Phone: 912-977-0584 | |
Ark La Tex Foot & Ankle Specialists, Llc Podiatrist Medicare: Medicare Enrolled Practice Location: 385 Bert Kouns, Bldg. 200, Shreveport, LA 71106 Phone: 318-687-8447 Fax: 318-687-9950 | |
Dr. Sheila D. Washington, D.P.M. Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 510 E Stoner Ave, Shreveport, LA 71101 Phone: 318-221-8411 |