Provider Demographics
NPI:1043316987
Name:PALMETTO PODIATRY GROUP OF ANDERSON, PA
Entity Type:Organization
Organization Name:PALMETTO PODIATRY GROUP OF ANDERSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-231-6395
Mailing Address - Street 1:2126 - B HWY 81 NORTH
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4819
Mailing Address - Country:US
Mailing Address - Phone:864-231-6395
Mailing Address - Fax:864-231-6520
Practice Address - Street 1:2126 - B HWY 81 NORTH
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4819
Practice Address - Country:US
Practice Address - Phone:864-231-6395
Practice Address - Fax:864-231-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9935Medicaid
SCCJ8533OtherMEDICARE RAILROAD
SC451213001OtherMEDICARE DME
SCGP9935Medicaid