Southside Foot Clinic of Shreveport, Inc. A Professional Corporation
NPI 1033111240ActiveOrganization· Podiatrist, Foot & Ankle Surgery· Shreveport, LA
Podiatrist, Foot & Ankle Surgery in Shreveport, Louisiana, registered in NPPES in June 2005. The authorized official on file is Richard Taylor Havens, D.P.M., Physician/Administrator. Enrolled in Medicare as dme supplier - physician - podiatry and part b supplier - clinic/group practice.
Overview
| NPI | 1033111240 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 1, 2005 |
| Last updated in NPPES | Dec 29, 2025 |
| Certified by provider | Dec 29, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Podiatrist, Foot & Ankle Surgery Primary | 213ES0103X | 5B496 | LA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Physician - Podiatry (LA); Part B Supplier - Clinic/Group Practice (LA) |
|---|
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