Provider Demographics
NPI:1497984397
Name:SOUTHERN PODIATRY FOOT AND ANKLE, PLLC
Entity Type:Organization
Organization Name:SOUTHERN PODIATRY FOOT AND ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-752-7713
Mailing Address - Street 1:1060 GRANDEVIEW BLVD
Mailing Address - Street 2:SUITE 623
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1497
Mailing Address - Country:US
Mailing Address - Phone:312-752-7713
Mailing Address - Fax:
Practice Address - Street 1:1060 GRANDEVIEW BLVD
Practice Address - Street 2:SUITE 623
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35824-1497
Practice Address - Country:US
Practice Address - Phone:312-752-7713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL299213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-49599OtherBCBSAL