Healthcare Provider Details

I. General information

NPI: 1922470624
Provider Name (Legal Business Name): INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 CAROLINA COMMONS DR STE 310
INDIAN LAND SC
29707-6071
US

IV. Provider business mailing address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-3338
  • Fax:
Mailing address:
  • Phone: 803-285-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BRANDON S PERCIVAL
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 803-285-1411