Provider Demographics
NPI:1699863027
Name:FOOT AND ANKLE OF THE CAROLINAS PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE OF THE CAROLINAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-845-2920
Mailing Address - Street 1:2950 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6722
Mailing Address - Country:US
Mailing Address - Phone:704-845-2920
Mailing Address - Fax:704-845-2921
Practice Address - Street 1:2950 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6722
Practice Address - Country:US
Practice Address - Phone:704-845-2920
Practice Address - Fax:704-845-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012J7Medicaid
NC012J7OtherBCBS GROUP
NC340515OtherMAMSI
NC463679OtherANTHEM
NC89012J7Medicaid
NC340515OtherMAMSI
NC89012J7Medicaid
NC6212890001Medicare NSC