Provider Demographics
NPI:1225195746
Name:MOORE FOOT & ANKLE SPECIALISTS, PA
Entity Type:Organization
Organization Name:MOORE FOOT & ANKLE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:828-350-1880
Mailing Address - Street 1:136 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1719
Mailing Address - Country:US
Mailing Address - Phone:828-350-1880
Mailing Address - Fax:828-252-2772
Practice Address - Street 1:136 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1719
Practice Address - Country:US
Practice Address - Phone:828-350-1880
Practice Address - Fax:828-252-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC467213E00000X, 213ES0103X
NC477213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016A1OtherBCBS
NC89016MWMedicaid
NC89016MWMedicaid
NC6195750001Medicare NSC