Provider Demographics
NPI:1073614384
Name:SALEM FOOT CARE, P.A.
Entity Type:Organization
Organization Name:SALEM FOOT CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FALARDEAU
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-667-2016
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-0087
Mailing Address - Country:US
Mailing Address - Phone:336-766-8985
Mailing Address - Fax:336-766-8722
Practice Address - Street 1:1505 RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7391
Practice Address - Country:US
Practice Address - Phone:336-667-2016
Practice Address - Fax:336-667-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC263213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908160Medicaid
NC8908160Medicaid
NCT64103Medicare UPIN
NC2432201Medicare PIN