Organization
MICHAEL R. TAMBLING
Active
Other names
Palmetto Pedorthic Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD G GRAHAM C.PED, O.S.T. (MANAGER)
(803) 269-3990
Entity
Organization
Contact information
Practice address
1671 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8626
(803) 269-3990
(803) 407-9195
Mailing address
1671 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8626
(803) 269-3990
(803) 407-9195
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C814
ANCILLARY CARE MANAGEMENT
SC
05
—
DM1013
—
SC
Enumeration date
12/04/2006
Last updated
12/29/2008
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