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General NPI Number Information
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NPI Number | 1114180825
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Entity Type | Organization
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Legal Business Name | PALMETTO FOOT CLINIC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 841 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-3082
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Country | US
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Telephone | 843-549-1800
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Fax | 843-549-1818
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Provider Business Mailing Address
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Address Line | 841 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-3082
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Country | US
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Telephone | 843-549-1800
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Fax | 843-549-1818
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. LANCE A SIMS
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Credential | DPM
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Telephone | 843-549-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 584
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License Number State | SC
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