Provider Demographics
NPI:1912209529
Name:EAST COOPER PODIATRY
Entity Type:Organization
Organization Name:EAST COOPER PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAWTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-881-3668
Mailing Address - Street 1:389 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2950
Mailing Address - Country:US
Mailing Address - Phone:843-881-3668
Mailing Address - Fax:859-737-0902
Practice Address - Street 1:389 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE # 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2968
Practice Address - Country:US
Practice Address - Phone:843-881-3668
Practice Address - Fax:859-737-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC078213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1145990001Medicare NSC