Provider Demographics
NPI:1457543589
Name:MID-CAROLINA PODIATRY, INC.
Entity Type:Organization
Organization Name:MID-CAROLINA PODIATRY, INC.
Other - Org Name:LEXINGTON FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-359-5435
Mailing Address - Street 1:1207 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7647
Mailing Address - Country:US
Mailing Address - Phone:803-359-5435
Mailing Address - Fax:803-359-4502
Practice Address - Street 1:1207 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7647
Practice Address - Country:US
Practice Address - Phone:803-359-5435
Practice Address - Fax:803-359-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00130213ES0131X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC18003OtherDMERC-PAYOR NUMBER
SCU48678Medicare UPIN
SC1150900001Medicare NSC
SC6186Medicare PIN