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General NPI Number Information
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NPI Number | 1336181668
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Entity Type | Organization
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Legal Business Name | PALMETTO PODIATRY GROUP OF ANDERSON, PA
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 430 S HERLONG AVE SUITE 105
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City | ROCK HILL
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State | SC
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Zip | 29732-9446
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Country | US
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Telephone | 803-327-2217
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Fax | 803-327-2272
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 803-327-2217
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Fax | 803-327-2272
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Authorized Official
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Title or Position | REGIONAL CREDENTIALING SPEICIALIST
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Name | KIYA BOYCE
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Credential |
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Telephone | 301-933-7133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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