Healthcare Provider Details

I. General information

NPI: 1578744843
Provider Name (Legal Business Name): CAROLINA FOOT CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HAMPTON ST
COLUMBIA SC
29201-3536
US

IV. Provider business mailing address

1900 HAMPTON ST
COLUMBIA SC
29201-3536
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-5005
  • Fax: 803-252-1720
Mailing address:
  • Phone: 803-779-5005
  • Fax: 803-252-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIM ANTHONY LANZA
Title or Position: OWNER
Credential: D.P.M.
Phone: 803-779-5005