Healthcare Provider Details

I. General information

NPI: 1336181668
Provider Name (Legal Business Name): PALMETTO PODIATRY GROUP OF ANDERSON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S HERLONG AVE SUITE 105
ROCK HILL SC
29732-9446
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-2217
  • Fax: 803-327-2272
Mailing address:
  • Phone: 803-327-2217
  • Fax: 803-327-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KIYA BOYCE
Title or Position: REGIONAL CREDENTIALING SPEICIALIST
Credential:
Phone: 301-933-7133