1396089223 NPI number — INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Table of content: SHANNON GILMAN BEHAVIOR SUPPORT (NPI 1851904353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396089223 NPI number — INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
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:
Provider Other Organization Name Type Code:
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:
1396089223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 N. TRADE STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-841-4000
Provider Business Mailing Address Fax Number:
704-841-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 N. TRADE STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-5018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-841-4000
Provider Business Practice Location Address Fax Number:
704-841-4338
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FUTERMAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
704-841-4000

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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