Provider Demographics
NPI:1649223389
Name:CAROLINA PODIATRY
Entity Type:Organization
Organization Name:CAROLINA PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-413-3100
Mailing Address - Street 1:506 EAST CHEVES ST
Mailing Address - Street 2:P. O. BOX 1905
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-1905
Mailing Address - Country:US
Mailing Address - Phone:843-413-3100
Mailing Address - Fax:843-413-3197
Practice Address - Street 1:506 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2616
Practice Address - Country:US
Practice Address - Phone:843-413-3100
Practice Address - Fax:843-413-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890805HMedicaid
SCPC0968Medicaid
SC0270850001Medicare NSC
SCC14658Medicare PIN
SC2669Medicare PIN
SC2669Medicare ID - Type Unspecified