Healthcare Provider Details

I. General information

NPI: 1003112731
Provider Name (Legal Business Name): ELGIN PODIATRY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR SUITE 110
COLUMBIA SC
29203-6849
US

IV. Provider business mailing address

3 RICHLAND MEDICAL PARK DR SUITE 110
COLUMBIA SC
29203-6849
US

V. Phone/Fax

Practice location:
  • Phone: 803-807-9388
  • Fax: 803-807-9391
Mailing address:
  • Phone: 803-807-9388
  • Fax: 803-807-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number571
License Number StateSC

VIII. Authorized Official

Name: DR. CHANSINA UM
Title or Position: OWNER
Credential: DPM
Phone: 803-586-5737