Provider Demographics
NPI:1306021654
Name:SIMS, LANCE AUSTEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:AUSTEN
Last Name:SIMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC584213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5845Medicaid
SCP00714163OtherRAILROAD MEDICARE
SCPD5845Medicaid