Provider Demographics
NPI:1619720083
Name:PALMETTO PODIATRY GROUP OF ANDERSON, PA
Entity Type:Organization
Organization Name:PALMETTO PODIATRY GROUP OF ANDERSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-897-2261
Mailing Address - Street 1:2126B HIGHWAY 81 N
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2126B HIGHWAY 81 N
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1532
Practice Address - Country:US
Practice Address - Phone:864-231-6395
Practice Address - Fax:864-231-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site