Provider Demographics
NPI:1104963529
Name:NEW RIVER FOOT&ANKLE INSTITUTE LLC
Entity type:Organization
Organization Name:NEW RIVER FOOT&ANKLE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-208-3338
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:BLDG#4 STE#21
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:843-208-3338
Mailing Address - Fax:
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:BLDG#4 STE#21
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty