Provider Demographics
NPI:1689609299
Name:CAROLINA FOOT SPECIALISTE LLC
Entity Type:Organization
Organization Name:CAROLINA FOOT SPECIALISTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-225-5575
Mailing Address - Street 1:615 WESLEY DR
Mailing Address - Street 2:#340
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7204
Mailing Address - Country:US
Mailing Address - Phone:843-225-5575
Mailing Address - Fax:843-225-5515
Practice Address - Street 1:615 WESLEY DR
Practice Address - Street 2:#340
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7204
Practice Address - Country:US
Practice Address - Phone:843-225-5575
Practice Address - Fax:843-225-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC545213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5453Medicaid
SC7295Medicare ID - Type Unspecified
SCU84926Medicare UPIN
SCPD5453Medicaid