Provider Demographics
NPI:1154486025
Name:RAPHA FAMILY FOOTCARE
Entity Type:Organization
Organization Name:RAPHA FAMILY FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEULAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-549-6271
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0016
Mailing Address - Country:US
Mailing Address - Phone:843-549-6271
Mailing Address - Fax:843-542-9030
Practice Address - Street 1:819 CARN ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-4322
Practice Address - Country:US
Practice Address - Phone:843-549-6271
Practice Address - Fax:843-542-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2876OtherMEDICAID DME
SCDF5446OtherRAILROAD MEDICARE
SCGP9915Medicaid
SC8646Medicare PIN
SCDE2876OtherMEDICAID DME