1255574497 NPI number — DUNES PODIATRY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255574497 NPI number — DUNES PODIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNES PODIATRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255574497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11945 GRANDHAVEN DR
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
MURRELLS INLET
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29576-8091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-357-3762
Provider Business Mailing Address Fax Number:
843-357-3772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11945 GRANDHAVEN DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-8091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-357-3762
Provider Business Practice Location Address Fax Number:
843-357-3772
Provider Enumeration Date:
04/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIGLIN
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
843-357-3762

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  594 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)