MEDICARE: DIAGNOSTIC & COMPREHENSIVE FOOT CARE

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	213ES0131X	Foot Surgery Podiatrist	SC519	SC

General Provider Information

NPI Number	:	1538211339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC & COMPREHENSIVE FOOT CARE

Provider Business Mailing Address
First Line	:	6941 N TRENHOLM RD STE H1
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-790-7200
Fax Number	:	803-790-0520

Provider Business Practice Location Address
First Line	:	6941 N TRENHOLM RD
Second Line	:	H1
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-790-7200
Fax Number	:	803-790-0520

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BYRON JACKSON
Credential	:	DPM
Telephone Number	:	803-790-7200

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	11/16/2007

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Directions to “DIAGNOSTIC & COMPREHENSIVE FOOT CARE ” Practice Location

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