Provider Demographics
NPI:1053091983
Name:FOOT SOUL FOOT & ANKLE, PLLC
Entity type:Organization
Organization Name:FOOT SOUL FOOT & ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-746-0600
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0275
Mailing Address - Country:US
Mailing Address - Phone:501-746-0600
Mailing Address - Fax:501-764-4060
Practice Address - Street 1:3395 HWY 5 N STE 200
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-9031
Practice Address - Country:US
Practice Address - Phone:501-746-0600
Practice Address - Fax:501-764-4060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT SOUL FOOT & ANKLE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-25
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty