Provider Demographics
NPI:1104997527
Name:LOW COUNTRY FAMILY PODIATRY
Entity type:Organization
Organization Name:LOW COUNTRY FAMILY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-553-2909
Mailing Address - Street 1:9313 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9155
Mailing Address - Country:US
Mailing Address - Phone:843-553-2909
Mailing Address - Fax:843-553-4684
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 301
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-553-2909
Practice Address - Fax:843-553-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC134213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9982Medicaid
SC5062Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
SCGP9982Medicaid