Provider Demographics
NPI:1639126808
Name:FOOT SOLUTIONS OF COLUMBIA LLC
Entity Type:Organization
Organization Name:FOOT SOLUTIONS OF COLUMBIA LLC
Other - Org Name:FOOT SOLUTIONS-COLUMBIA, SC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-781-1230
Mailing Address - Street 1:7001 SAINT ANDREWS RD
Mailing Address - Street 2:SUITE A-17
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-781-1960
Mailing Address - Fax:
Practice Address - Street 1:7001 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1137
Practice Address - Country:US
Practice Address - Phone:803-781-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1957Medicaid
SCDE1957Medicaid