Provider Demographics
NPI:1124044201
Name:EAST COOPER PODIATRY, P.A.
Entity type:Organization
Organization Name:EAST COOPER PODIATRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-881-3668
Mailing Address - Street 1:389 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2950
Mailing Address - Country:US
Mailing Address - Phone:843-881-3668
Mailing Address - Fax:843-881-9191
Practice Address - Street 1:389 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2950
Practice Address - Country:US
Practice Address - Phone:843-881-3668
Practice Address - Fax:843-881-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD1279Medicaid
SC5959970001Medicare NSC
U34001Medicare UPIN