Provider Demographics
NPI:1033376959
Name:WAKE FOOT AND ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:WAKE FOOT AND ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-570-9061
Mailing Address - Street 1:833 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:STE C
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6519
Mailing Address - Country:US
Mailing Address - Phone:919-570-9061
Mailing Address - Fax:919-570-9064
Practice Address - Street 1:833 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:STE C
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6519
Practice Address - Country:US
Practice Address - Phone:919-570-9061
Practice Address - Fax:919-570-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4409840002Medicare NSC