Provider Demographics
NPI:1467547588
Name:MID-SOUTH FOOT AND ANKLE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:MID-SOUTH FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-309-7700
Mailing Address - Street 1:8055 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5967
Mailing Address - Country:US
Mailing Address - Phone:901-309-7700
Mailing Address - Fax:901-507-3297
Practice Address - Street 1:8055 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5967
Practice Address - Country:US
Practice Address - Phone:901-309-7700
Practice Address - Fax:901-507-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353819Medicaid
TN3353819Medicare ID - Type UnspecifiedGROUP NUMBER
TN3353819Medicaid