| Organization Name: | SOUTH COAST FOOT AND ANKLE INC |
| NPI Number: | 1720356942 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROSE S SOUTHERLAND (OWNER) |
| Mailing Address: | 25 Union School Rd Nw Suite 1 Ocean Isle Beach |
| State: | NC US |
| Postal Code: | 284697307 |
| Phone Number: | 9105790828 |
| Fax Number: | 9105795463 |
| NPI Enumeration Date: | 12/02/2011 |
| NPI Last Update Date: | 06/11/2012 |
| 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: | |