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SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC

Podiatric Medicine & Surgery Service Providers Podiatrist Foot & Ankle Surgery

Provider NPI: 1659797140

Organization Information:
Organization Name:  SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Organization is not Subpart
Authorized Official:  BRANDON  PERCIVAL  PRESIDENT  803-285-1411

Practice Location:
8141 ROURK ST  MYRTLE BEACH, SC 29572-4128 US
Tel: 843-449-8079  Fax: 843-497-6147

Business Mailing Address:
8141 ROURK ST  MYRTLE BEACH, SC 29572-4128 US
Tel: 843-449-8079  Fax: 843-497-6147

NPI Information:
NPI: 1659797140
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
Foot & Ankle Surgery
SC
N213ES0131XPodiatric Medicine & Surgery Service Providers
Podiatrist
SC
Y213E00000XPodiatric Medicine & Surgery Service Providers
Podiatrist
SC

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 213E00000X

Type:

Classification:



Definition:



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