Provider Demographics
NPI:1154571495
Name:MID-SOUTH FOOT & ANKLE CLINIC P C
Entity type:Organization
Organization Name:MID-SOUTH FOOT & ANKLE CLINIC P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BHEKUMUZI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHUMALO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:870-732-3131
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-1118
Mailing Address - Country:US
Mailing Address - Phone:870-732-3131
Mailing Address - Fax:870-732-1301
Practice Address - Street 1:302 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-732-3131
Practice Address - Fax:870-732-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty