Provider Demographics
NPI:1063566313
Name:FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC
Entity type:Organization
Organization Name:FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KASHEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-690-1144
Mailing Address - Street 1:1104 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2552
Mailing Address - Country:US
Mailing Address - Phone:919-690-1144
Mailing Address - Fax:919-693-9255
Practice Address - Street 1:1104 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2552
Practice Address - Country:US
Practice Address - Phone:919-690-1144
Practice Address - Fax:919-693-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790211PMedicaid
NC0211POtherBC BS
NC0211POtherBC BS
NC790211PMedicaid
NC2433237DMedicare PIN