Provider Demographics
NPI:1194961953
Name:NORTH SIDE FOOT CLINIC P.C.
Entity type:Organization
Organization Name:NORTH SIDE FOOT CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-385-1590
Mailing Address - Street 1:4451 NATURAL BRIDGE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2628
Mailing Address - Country:US
Mailing Address - Phone:314-385-1590
Mailing Address - Fax:314-385-1606
Practice Address - Street 1:4451 NATURAL BRIDGE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2628
Practice Address - Country:US
Practice Address - Phone:314-385-1590
Practice Address - Fax:314-385-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000359213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174744320OtherNPI NUMBER
1174744320OtherNPI NUMBER