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General NPI Number Information
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NPI Number | 1295788354
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Entity Type | Organization
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Legal Business Name | PALMETTO PODIATRY ASSOCIATES LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 1730 HENDERSON STREET SUITE B
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 803-376-1717
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Fax | 803-376-1716
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Provider Business Mailing Address
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Address Line | 1730 HENDERSON STREET SUITE B
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 803-376-1717
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Fax | 803-376-1716
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH J MORAN
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Credential | DPM
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Telephone | 803-376-1717
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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 | 00151
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 00151
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License Number State | SC
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