Healthcare Provider Details

I. General information

NPI: 1669589834
Provider Name (Legal Business Name): COLUMBIA FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 CALHOUN ST
COLUMBIA SC
29201-2607
US

IV. Provider business mailing address

1516 CALHOUNS STREET
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-6114
  • Fax: 803-254-7674
Mailing address:
  • Phone: 803-254-6114
  • Fax: 803-254-7674

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. RALPH E PAYNE
Title or Position: DOCTOR ASSOCIATE
Credential: DPM
Phone: 803-254-6114