Provider Demographics
NPI:1427473966
Name:FOOT CLINIC OF SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:FOOT CLINIC OF SOUTH CAROLINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-281-9171
Mailing Address - Street 1:211 E BUTLER RD STE A2
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2170
Mailing Address - Country:US
Mailing Address - Phone:864-281-9171
Mailing Address - Fax:
Practice Address - Street 1:211 E BUTLER RD
Practice Address - Street 2:SUITE A2
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2169
Practice Address - Country:US
Practice Address - Phone:864-281-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty