| NPI | 1821282146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE H WELLMON Dpm 864-487-5516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 86) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SC 86) |
| 213E00000X Podiatrist (Licence: NC 216) | |
| 213E00000X Podiatrist (Licence: FL 1738) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2022-08-29 |