Healthcare Provider Details

I. General information

NPI: 1063220671
Provider Name (Legal Business Name): PIKE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WOODSON ST
GREENVILLE SC
29611-7561
US

IV. Provider business mailing address

111 WOODSON ST
GREENVILLE SC
29611-7561
US

V. Phone/Fax

Practice location:
  • Phone: 864-248-6272
  • Fax:
Mailing address:
  • Phone: 864-248-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CASSANDRA W PIKE
Title or Position: OWNER
Credential: DPM
Phone: 864-248-6272