Provider Demographics
NPI:1578744843
Name:CAROLINA FOOT CLINIC, P.C.
Entity Type:Organization
Organization Name:CAROLINA FOOT CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-779-5005
Mailing Address - Street 1:1900 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3536
Mailing Address - Country:US
Mailing Address - Phone:803-779-5005
Mailing Address - Fax:803-252-1720
Practice Address - Street 1:1900 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3536
Practice Address - Country:US
Practice Address - Phone:803-779-5005
Practice Address - Fax:803-252-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6014Medicare PIN