MEDICARE: PHYSICIANS FOOTCARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207ZP0101X	Anatomic Pathology Physician
3	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN1264	OTHER	SC	MEDICARE RR

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	:	1194909556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS FOOTCARE, LLC

Provider Business Mailing Address
First Line	:	1608 WESTMINSTER DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2018
Country	:	US
Telephone Number	:	803-256-6776
Fax Number	:	803-256-6778

Provider Business Practice Location Address
First Line	:	1608 WESTMINSTER DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2018
Country	:	US
Telephone Number	:	803-256-6776
Fax Number	:	803-256-6778

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KEVIN L. RAY
Credential	:	DPM
Telephone Number	:	803-256-6776

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	04/14/2026

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Directions to “PHYSICIANS FOOTCARE, LLC ” Practice Location

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