Provider Demographics
NPI:1720356942
Name:SOUTH COAST FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:SOUTH COAST FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-579-0828
Mailing Address - Street 1:25 UNION SCHOOL RD NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-7307
Mailing Address - Country:US
Mailing Address - Phone:910-579-0828
Mailing Address - Fax:910-579-5463
Practice Address - Street 1:25 UNION SCHOOL RD NW
Practice Address - Street 2:SUITE 1
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-7307
Practice Address - Country:US
Practice Address - Phone:910-579-0828
Practice Address - Fax:910-579-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty