Provider Demographics
NPI:1194783233
Name:PIEDMONT FOOT CLINIC, PA
Entity type:Organization
Organization Name:PIEDMONT FOOT CLINIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MALICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-481-3338
Mailing Address - Street 1:103 PARKWAY OFFICE COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7429
Mailing Address - Country:US
Mailing Address - Phone:919-481-3338
Mailing Address - Fax:919-467-2436
Practice Address - Street 1:103 PARKWAY OFFICE COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7429
Practice Address - Country:US
Practice Address - Phone:919-481-3338
Practice Address - Fax:919-467-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890803AMedicaid
NC0803AOtherBCBS OF NC GROUP #
NC890803AMedicaid
NCC12484Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC0988540001Medicare ID - Type UnspecifiedPALMETTO REGION C