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General NPI Number Information
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NPI Number | 1447496716
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Entity Type | Organization
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Legal Business Name | CAROLINA PEDORTHIC, LLC
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 1000 N PINE ST SUITE 19
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City | SPARTANBURG
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State | SC
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Zip | 29303-3151
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Country | US
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Telephone | 864-583-4456
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Fax | 864-582-2728
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Provider Business Mailing Address
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Address Line | 1000 N PINE ST SUITE 19
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City | SPARTANBURG
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State | SC
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Zip | 29303-3151
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Country | US
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Telephone | 864-583-4456
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Fax | 864-582-2728
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN MARK ROGERS
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Credential | PEDORTHIST
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Telephone | 864-583-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | SC
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