Provider Demographics
NPI:1225093933
Name:PIEDMONT PODIATRY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PIEDMONT PODIATRY ASSOCIATES, PLLC
Other - Org Name:PIEDMONT FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRY
Authorized Official - Phone:336-627-4861
Mailing Address - Street 1:307 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-3815
Mailing Address - Country:US
Mailing Address - Phone:336-342-5701
Mailing Address - Fax:336-342-1373
Practice Address - Street 1:307 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3815
Practice Address - Country:US
Practice Address - Phone:336-342-5701
Practice Address - Fax:336-342-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC304213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0611010003Medicare NSC
NC2432292EMedicare PIN
NC243072BMedicare PIN
NCT64039Medicare UPIN
NCU02680Medicare UPIN