Provider Demographics
NPI:1720376130
Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Other - Org Name:PALMETTO PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RSFPP
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-724-2910
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2075 EAGLE LANDING BLVD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4074
Practice Address - Country:US
Practice Address - Phone:843-881-9158
Practice Address - Fax:843-971-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDP0704OtherRAILROAD MEDICARE GROUP ID-RSFPN
SCDP0704OtherRAILROAD MEDICARE GROUP ID-RSFPN