Healthcare Provider Details

I. General information

NPI: 1194371161
Provider Name (Legal Business Name): NORTH SHORE FOOT & ANKLE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 S SHEPHERDS GLN
WICHITA FALLS TX
76308-5449
US

IV. Provider business mailing address

2101 SHANNON OXMOOR RD # 82
SHANNON AL
35142-2000
US

V. Phone/Fax

Practice location:
  • Phone: 888-212-4242
  • Fax:
Mailing address:
  • Phone: 888-212-4243
  • Fax: 205-847-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHESTER WILLIAMS III
Title or Position: PRESIDENT
Credential: DPM
Phone: 888-212-4243