Provider Demographics
NPI:1851361984
Name:MCANINCH, WILLIAM JAY (PODIATRIST)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAY
Last Name:MCANINCH
Suffix:
Gender:M
Credentials:PODIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2533
Mailing Address - Country:US
Mailing Address - Phone:864-329-0655
Mailing Address - Fax:864-640-4553
Practice Address - Street 1:1754 WOODRUFF RD
Practice Address - Street 2:308
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5933
Practice Address - Country:US
Practice Address - Phone:864-640-4595
Practice Address - Fax:864-640-4553
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9973Medicaid
SCT24796Medicare UPIN
SC5480Medicare ID - Type UnspecifiedPROVIDER NUMBER
SCGP9973Medicaid