Provider Demographics
NPI:1255421988
Name:CAMDEN FOOT CLINIC
Entity type:Organization
Organization Name:CAMDEN FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-669-2709
Mailing Address - Street 1:133 SPARKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-9197
Mailing Address - Country:US
Mailing Address - Phone:803-669-2709
Mailing Address - Fax:803-713-1310
Practice Address - Street 1:133 SPARKLEBERRY LN
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-9197
Practice Address - Country:US
Practice Address - Phone:803-669-2709
Practice Address - Fax:803-713-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC547213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC480031163OtherMEDICARE RAILROAD PIN
SCPD5473Medicaid
SC6072870001Medicare NSC
SC480031163OtherMEDICARE RAILROAD PIN
SC8591Medicare PIN