Healthcare Provider Details

I. General information

NPI: 1790813566
Provider Name (Legal Business Name): SEACOAST PODIATRY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SAWTELL RD
LITTLE RIVER SC
29566-7873
US

IV. Provider business mailing address

3700 SAWTELL RD
LITTLE RIVER SC
29566-7873
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-1333
  • Fax: 843-390-1633
Mailing address:
  • Phone: 843-390-1333
  • Fax: 843-390-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number546
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number539
License Number StateSC

VIII. Authorized Official

Name: DR. BRADLEY JAMES KEEFER
Title or Position: PARTNER
Credential: DPM
Phone: 843-390-1333