Coastal Podiatry, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

607 Issued in SC

Legal business name

COASTAL PODIATRY, LLC

Practice address

180 Wingo Way
Suite 201
Mount Pleasant, SC 29464-1810

Phone

(916) 215-1234

Fax

(843) 606-2483

NPI assigned

Nov 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tamika Michelle Bolden Ravenell, DPM

Title

Owner

Phone

(916) 215-1234

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1659648152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 783",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294650783",
            "telephone_number": "916-215-1234",
            "fax_number": "843-606-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WINGO WAY",
            "address_2": "SUITE 201",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294641810",
            "telephone_number": "916-215-1234",
            "fax_number": "843-606-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-28",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "BOLDEN RAVENELL",
        "authorized_official_first_name": "TAMIKA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-215-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "SC",
            "license": "607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Podiatrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.