DR. CHARLES C SOUTHERLAND DPM - NPI 1306832944 - Podiatrist in Eagle Mountain, UT

Q: What is Charles Southerland's NPI number?

The NPI number for Charles Southerland is 1306832944. It was assigned to this individual provider in the NPPES registry on September 20, 2005.

Q: What is Charles Southerland's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

On this page

About Dr. Charles C Southerland Dpm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES C SOUTHERLAND DPM (NPI 1306832944) is an individual foot & ankle surgery provider in Eagle Mountain, Utah, licensed in Utah (9244891-0501) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1306832944

Entity TypeIndividualMale

Primary Taxonomy213ES0103X

Provider Legal NameDR. CHARLES C SOUTHERLANDCredential: DPM

Location Address3435 E PONY EXPRESS PKWY STE 140Eagle Mountain, UT 84005-5548

Mailing Address11300 Ne 2nd AvenueMiami Shores, FL 33161 · (305) 693-7287 · Fax (305) 694-9616

Phone(801) 893-8811

Sole ProprietorNo

Enumeration DateSeptember 20, 2005

Last NPPES UpdateApril 24, 20202 updates tracked since enumeration

NPPES CertifiedApril 24, 2020

✔ NPI 1306832944 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers

Taxonomy Code213ES0103X

License✔ Licensed in UT · 9244891-0501

3435 E PONY EXPRESS PKWY STE 140, Eagle Mountain, UT 84005

Open in Google Maps ↗

Secondary Practice Locations 2

Location 11973 N State StProvo, UT 84604-1012 · Phone (801) 373-2499 · Fax (801) 373-5200

Location 28822 S Redwood Rd Ste E121West Jordan, UT 84088-5763 · Phone (801) 285-7060 · Fax (801) 285-7061

Other Identifiers 1

Other9244891-0501UT · Medical License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Charles C Southerland Dpm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BROOKE LUDWIG

Nurse Practitioner (Primary Care)