Provider Demographics
NPI:1750168563
Name:PHYSICIAN FOOTCARE SURGERY CENTER
Entity type:Organization
Organization Name:PHYSICIAN FOOTCARE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, JD
Authorized Official - Phone:803-531-2888
Mailing Address - Street 1:718 BROUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6648
Mailing Address - Country:US
Mailing Address - Phone:803-531-2888
Mailing Address - Fax:803-531-2813
Practice Address - Street 1:709 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3411
Practice Address - Country:US
Practice Address - Phone:843-665-4567
Practice Address - Fax:843-665-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical