Organization Name: | FOOT CLINIC OF SOUTH CAROLINA, LLC |
NPI Number: | 1427473966 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRAD LINDSTROM (PRESIDENT) |
Mailing Address: | 211 E Butler Rd Suite A2 Mauldin |
State: | SC US |
Postal Code: | 296622169 |
Phone Number: | 8642819171 |
Fax Number: | |
NPI Enumeration Date: | 02/20/2014 |
NPI Last Update Date: | 11/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |