Provider Demographics
NPI:1073688123
Name:EASTERN CAROLINA FOOT AN ANKLE SPECIALISTS, INC
Entity Type:Organization
Organization Name:EASTERN CAROLINA FOOT AN ANKLE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GAULAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-830-1000
Mailing Address - Street 1:2140 W ARLINGTON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5709
Mailing Address - Country:US
Mailing Address - Phone:252-830-1000
Mailing Address - Fax:252-830-0511
Practice Address - Street 1:2140 W ARLINGTON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-830-1000
Practice Address - Fax:252-830-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC361213E00000X
NC435213E00000X
NC485213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0182YOtherBCBSNC
NC890182YMedicaid
NC=========001OtherTRICARE
NC1206340001Medicare NSC
NC0182YOtherBCBSNC
NC2322917Medicare PIN