MEDICARE: FOOT CLINIC OF SOUTH CAROLINA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1427473966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT CLINIC OF SOUTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	211 E BUTLER RD STE A2
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2170
Country	:	US
Telephone Number	:	864-281-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E BUTLER RD
Second Line	:	SUITE A2
City	:	MAULDIN
State	:	SC
Zip	:	29662-2169
Country	:	US
Telephone Number	:	864-281-9171
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRAD LINDSTROM
Credential	:	DPM
Telephone Number	:	864-281-9171

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	11/12/2015

Similar Medicare Providers

1609850122 — DR. BRAD A. LINDSTROM DPM
Practice Location Address:

211 E BUTLER RD , SUITE A-2
MAULDIN, SC
29662-2169

Practice Phone: 864-281-9171
Practice Fax: 864-281-9170

1861538969 — FOOT CLINIC OF SOUTH CAROLINA, LLC
Practice Location Address:

211 E BUTLER RD , SUITE A2
MAULDIN, SC
29662-2169

Practice Phone: 864-281-9171
Practice Fax: 978-327-7938

1518426295 — DYLAN MICHAEL CARLISLE
Practice Location Address:

211 E BUTLER RD
MAULDIN, SC
29662-2169

Practice Phone: 864-281-9171
Practice Fax:

1417889825 — EMILY TROTTER
Practice Location Address:

10 WINCHESTER CT
MAULDIN, SC
29662-2627

Practice Phone: 706-842-5330
Practice Fax: 706-842-5340

1962495531 — NAVNEET GUPTA MD
Practice Location Address:

213 E BUTLER ROAD , SUITE F1
MAULDIN, SC
29662-2172

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1336139971 — DR. MELVIN HANK SEID MD
Practice Location Address:

10 CENTIMETERS DR
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29662-3278

Practice Phone: 800-867-2289
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