Provider Demographics
NPI:1316185010
Name:TOTAL FOOT CARE, LLC
Entity Type:Organization
Organization Name:TOTAL FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-445-5158
Mailing Address - Street 1:104 TRADITIONS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8050
Mailing Address - Country:US
Mailing Address - Phone:888-548-2388
Mailing Address - Fax:800-230-8028
Practice Address - Street 1:104 TRADITIONS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8050
Practice Address - Country:US
Practice Address - Phone:888-548-2388
Practice Address - Fax:800-230-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9904Medicaid
SCGP9904Medicaid