MEDICARE: PALMETTO PODIATRY GROUP OF ANDERSON, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ8533	OTHER	SC	MEDICARE RAILROAD
3	451213001	OTHER	SC	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043316987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PODIATRY GROUP OF ANDERSON, PA

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:	864-231-6395
Fax Number	:	864-231-6520

Provider Business Practice Location Address
First Line	:	2126 - B HWY 81 NORTH
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-231-6395
Fax Number	:	864-231-6520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES L ROSE
Credential	:	DPM
Telephone Number	:	864-231-6395

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/26/2025

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