Healthcare Provider Details

I. General information

NPI: 1194909556
Provider Name (Legal Business Name): PHYSICIANS FOOTCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 WESTMINSTER DR
COLUMBIA SC
29204-2018
US

IV. Provider business mailing address

1608 WESTMINSTER DR
COLUMBIA SC
29204-2018
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-6776
  • Fax: 803-256-6778
Mailing address:
  • Phone: 803-256-6776
  • Fax: 803-256-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN L. RAY
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 803-256-6776