Provider Demographics
NPI:1245780303
Name:TARHEEL FOOT & SPECIALTY CARE, P.A.
Entity Type:Organization
Organization Name:TARHEEL FOOT & SPECIALTY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-929-6944
Mailing Address - Street 1:300 BIRCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3297
Mailing Address - Country:US
Mailing Address - Phone:910-904-6600
Mailing Address - Fax:910-904-1810
Practice Address - Street 1:300 BIRCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3297
Practice Address - Country:US
Practice Address - Phone:910-904-6600
Practice Address - Fax:910-904-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900257207QA0505X
363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty