Provider Demographics
NPI:1114180825
Name:PALMETTO FOOT CLINIC
Entity Type:Organization
Organization Name:PALMETTO FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-549-1800
Mailing Address - Street 1:841 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3082
Mailing Address - Country:US
Mailing Address - Phone:843-549-1800
Mailing Address - Fax:843-549-1818
Practice Address - Street 1:841 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3082
Practice Address - Country:US
Practice Address - Phone:843-549-1800
Practice Address - Fax:843-549-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC584213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO8910OtherRAILROAD MEDICARE
SCGP9905Medicaid
SC9032Medicare PIN