Provider Demographics
NPI:1548443682
Name:SOUTHERN FOOT & ANKLE CENTER PC
Entity type:Organization
Organization Name:SOUTHERN FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-355-3555
Mailing Address - Street 1:836 E 65TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4434
Mailing Address - Country:US
Mailing Address - Phone:912-355-3555
Mailing Address - Fax:912-355-4499
Practice Address - Street 1:14 OKATIE CENTER BLVD S BLDG 14
Practice Address - Street 2:SUITE 101
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7506
Practice Address - Country:US
Practice Address - Phone:912-355-3555
Practice Address - Fax:912-355-4499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN FOOT & ANKLE CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGDP847Medicaid
SCGDP847Medicaid