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Organization

CAROLINA PODIATRY CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN KSOR DPM (PODIATRIST)
(864) 494-0534
Entity
Organization

Contact information

Practice address
2502 BROAD ST, CAMDEN, SC 29020
(803) 425-5510
(803) 432-4776
Mailing address
2604 BROAD ST, CAMDEN, SC 29020-2240
(803) 425-5510
(803) 432-4776

Taxonomy

Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
563
SC
332B00000X
Durable Medical Equipment & Medical Supplies
6460510001
SC
332B00000X
Durable Medical Equipment & Medical Supplies
DE3794
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DQ3852
RR MEDICARE
SC
05
GP9894
SC
Enumeration date
02/25/2010
Last updated
08/17/2018
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