Organization
UPSTATE PODIATRY GROUP
Active
Parent organization
UPSTATE PODIATRY GROUP, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
UPSTATE PODIATRY GROUP, PA
Authorized official
STEPHANIE RIDDLE (CFO)
(864) 399-9070
Entity
Organization
Contact information
Practice address
1010 W MAIN ST, LAURENS, SC 29360-2608
(864) 399-9070
Mailing address
801 SE MAIN ST, SIMPSONVILLE, SC 29681-7150
(864) 399-9070
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/16/2021
Last updated
06/16/2021
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