Provider Demographics
NPI:1164626487
Name:ORTHOPEDIC SURGERY SPECIALIZING IN THE FOOT AND ANKLE, P.A.
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY SPECIALIZING IN THE FOOT AND ANKLE, P.A.
Other - Org Name:OSFA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-838-5254
Mailing Address - Street 1:600 N PERSON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1214
Mailing Address - Country:US
Mailing Address - Phone:919-838-5254
Mailing Address - Fax:919-838-5201
Practice Address - Street 1:600 N PERSON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1214
Practice Address - Country:US
Practice Address - Phone:919-838-5254
Practice Address - Fax:919-838-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127E0Medicaid
NC2337995Medicare ID - Type UnspecifiedMCARE GRP #
NC89127E0Medicaid