Provider Demographics
NPI:1104170638
Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-504-1004
Mailing Address - Street 1:11030 S TRYON ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6545
Mailing Address - Country:US
Mailing Address - Phone:704-504-1004
Mailing Address - Fax:
Practice Address - Street 1:11030 S TRYON ST
Practice Address - Street 2:SUITE 308
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6545
Practice Address - Country:US
Practice Address - Phone:704-504-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89081AVMedicaid
NC6712460003Medicare NSC
NC89081AVMedicaid