Provider Demographics
NPI:1346256161
Name:MYERS PODIATRY CLINIC
Entity Type:Organization
Organization Name:MYERS PODIATRY CLINIC
Other - Org Name:MYERS PODIATRY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-347-3334
Mailing Address - Street 1:2376 CYPRESS CIRCLE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8994
Mailing Address - Country:US
Mailing Address - Phone:843-347-3334
Mailing Address - Fax:
Practice Address - Street 1:2376 CYPRESS CIRCLE
Practice Address - Street 2:SUITE 201
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8994
Practice Address - Country:US
Practice Address - Phone:843-347-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 531213ES0131X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9923Medicaid
5425660001Medicare NSC
SCGP9923Medicaid