Provider Demographics
NPI:1467571919
Name:CHERAW FOOT CENTER PC
Entity Type:Organization
Organization Name:CHERAW FOOT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-921-6711
Mailing Address - Street 1:110 S DOCTORS DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7112
Mailing Address - Country:US
Mailing Address - Phone:843-921-6711
Mailing Address - Fax:843-921-6717
Practice Address - Street 1:110 S DOCTORS DR
Practice Address - Street 2:SUITE B1
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7112
Practice Address - Country:US
Practice Address - Phone:843-921-6711
Practice Address - Fax:843-921-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC522213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5220Medicaid
SCU73910Medicare UPIN
SCU739100281Medicare ID - Type Unspecified
SCPD5220Medicaid