Provider Demographics
NPI:1518048404
Name:PEE DEE FOOT CENTER, PA
Entity Type:Organization
Organization Name:PEE DEE FOOT CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-355-9690
Mailing Address - Street 1:402 NELSON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4058
Mailing Address - Country:US
Mailing Address - Phone:843-355-9690
Mailing Address - Fax:843-355-9777
Practice Address - Street 1:402 NELSON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4058
Practice Address - Country:US
Practice Address - Phone:843-355-9690
Practice Address - Fax:843-355-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC527213ES0103X
SC532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCF8526OtherRAILROAD MEDICARE
SCDE1502OtherMEDICAID DME
SCGP9963Medicaid
SCCF8526OtherRAILROAD MEDICARE
6370Medicare ID - Type Unspecified