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General NPI Number Information
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NPI Number | 1871011387
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Entity Type | Organization
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Legal Business Name | HONORED TO SERVE, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 4100 N MAIN ST STE 204
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City | COLUMBIA
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State | SC
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Zip | 29203-5800
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Country | US
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Telephone | 803-401-5356
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 N MAIN ST STE 204
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City | COLUMBIA
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State | SC
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Zip | 29203-5800
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Country | US
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Telephone | 803-401-5356
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Fax | 803-497-3844
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE P GLOVER
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Credential | DPM
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Telephone | 803-401-5356
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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 | POD001155
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License Number State | SC
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