1194857342 NPI number — PODIATRY ASSOCIATES, P.A., LOW COUNTRY FOOT & ANKLE INSTITUTE, INC.

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 1194857342 NPI number — PODIATRY ASSOCIATES, P.A., LOW COUNTRY FOOT & ANKLE INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY ASSOCIATES, P.A., LOW COUNTRY FOOT & ANKLE INSTITUTE, INC.
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:
1194857342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1084 RIBAUT RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-5497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-524-0232
Provider Business Mailing Address Fax Number:
843-524-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1084 RIBAUT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29902-5494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-524-0232
Provider Business Practice Location Address Fax Number:
843-524-3323
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STATLER
Authorized Official First Name:
TRENTON
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN/PARTNER
Authorized Official Telephone Number:
843-524-0232

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  007222542 , 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)





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