South Carolina Podiatric Physicians and Surgeons Group, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC

Practice address

166 Waccamaw Medical Park CT
Conway, SC 29526-8965

Phone

(843) 449-8079

Fax

(843) 497-6147

NPI assigned

Mar 9, 2014

Last updated

Mar 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brandon PercivalNPI 1518930817

Title

President

Phone

(803) 285-1411

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon Scot Percival, D.P.M.

  • Podiatrist
  • Lancaster, SC
  • NPI 1518930817
  Authorized official Same address or phone

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

{
    "created_epoch": "1394323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394323200000",
    "number": "1922424423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8141 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724128",
            "telephone_number": "843-449-8079",
            "fax_number": "843-497-6147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 WACCAMAW MEDICAL PARK CT",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268965",
            "telephone_number": "843-449-8079",
            "fax_number": "843-497-6147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-09",
        "last_updated": "2014-03-09",
        "status": "A",
        "authorized_official_last_name": "PERCIVAL",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-285-1411"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Carolina Department of Health and Environmental Control (Region 6 Department of Public Health)
• South Carolina Dept of Mental Health Accounting Office (Waccamaw Center for Mental Health)
• South Carolina Dhec (Waccamaw CRS)
• South Carolina Dhec (SC DHEC Region 06 DSME)
• South Carolina Interventionists, Inc.
• South Carolina Podiatric Physicians and Surgeons Group,LLC
• South Carolina Podiatric Physicians and Surgeons Group,LLC
• South Carolina Retina Institute LLC
• Southern Oak Dental Conway, LLC
• Southern Oak Dental, LLC

• Podiatrist in Conway, SC
• Providers in Conway, SC by specialty
• Podiatrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2014; 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.