Provider Demographics
NPI:1356642086
Name:ASSOCIATED FOOT SPECIALISTS, PA
Entity Type:Organization
Organization Name:ASSOCIATED FOOT SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAVENELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-856-5337
Mailing Address - Street 1:180 WINGO WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1810
Mailing Address - Country:US
Mailing Address - Phone:843-856-5337
Mailing Address - Fax:
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-856-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty