1639353857 NPI number — FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC

Table of content: (NPI 1639353857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639353857 NPI number — FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC
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:
UNC PODIATRY SERVICES
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:
1639353857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SPRING DELL LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-475-4246
Provider Business Mailing Address Fax Number:
919-693-9255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5316 HIGHGATE DR
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-484-1437
Provider Business Practice Location Address Fax Number:
919-806-2181
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KASHEFSKY
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
EVAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-475-4246

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  402 , 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)

  • Identifier: 790211P , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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