MEDICARE: FOOT SOLUTIONS OF COLUMBIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639126808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT SOLUTIONS OF COLUMBIA LLC

Provider Business Mailing Address
First Line	:	7001 SAINT ANDREWS RD
Second Line	:	SUITE A-17
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-781-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-781-1960
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANICE ALLEN
Credential	:
Telephone Number	:	803-781-1230

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/18/2012

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