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NPI Code Detail

MEDICARE: MID-CAROLINA PODIATRY, INC.

MEDICARE: MID-CAROLINA PODIATRY, INC.
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
1213ES0131XFoot Surgery Podiatrist00130SC
2335E00000XProsthetic/Orthotic Supplier00130SC
3332BC3200XCustomized Equipment (DME)00130SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118003OTHERSCDMERC-PAYOR NUMBER

General Provider Information

NPI Number : 1457543589
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-CAROLINA PODIATRY, INC.
Provider Business Mailing Address
First Line : 1207 N LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7647
Country : US
Telephone Number : 803-359-5435
Fax Number : 803-359-4502
Provider Business Practice Location Address
First Line : 1207 N LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7647
Country : US
Telephone Number : 803-359-5435
Fax Number : 803-359-4502
Authorized Official
Title or Position : PRESIDENT
Name : PAUL R BEARDEN
Credential : D.P.M.
Telephone Number : 803-359-5435
Provider Enumeration Date : 08/13/2007
Last Update Date : 04/10/2008

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Directions to “MID-CAROLINA PODIATRY, INC. ” Practice Location

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