1376043349 NPI number — GREATER CHARLOTTE FOOT AND ANKLE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376043349 NPI number — GREATER CHARLOTTE FOOT AND ANKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER CHARLOTTE FOOT AND ANKLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHARLOTTE FOOT CARE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376043349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13425 HOOVER CREEK BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-0054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-228-1350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13425 HOOVER CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-228-1350
Provider Business Practice Location Address Fax Number:
704-461-0991
Provider Enumeration Date:
02/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LU
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-228-1350

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  619 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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