Provider Demographics
NPI:1669859104
Name:MOBILE PODIATRY SOUTH CAROLINA
Entity Type:Organization
Organization Name:MOBILE PODIATRY SOUTH CAROLINA
Other - Org Name:SPECIAL CARE PODIATRY OF SOUTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYOKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-570-2209
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0705
Mailing Address - Country:US
Mailing Address - Phone:803-570-2209
Mailing Address - Fax:888-866-4740
Practice Address - Street 1:10 SUMMERLEA LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3915
Practice Address - Country:US
Practice Address - Phone:803-570-2209
Practice Address - Fax:888-866-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty