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

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 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:
Provider Other Organization Name Type Code:
6
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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