| NPI | 1720032816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK R KUTYLA President 803-356-4712 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: SC 516) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: SC 516) |
| 213ES0000X Podiatrist Sports Medicine (Licence: SC 516) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: SC 516) | |
| 2471M1202X Radiologic Technologist Magnetic Resonance Imaging (Licence: SC 516) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 516) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: SC 516) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: SC 516) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2011-11-06 |