Provider Demographics
NPI:1306022165
Name:FAMILY FOOT & ANKLE CENTER, PA
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-872-2022
Mailing Address - Street 1:451 RUIN CREEK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5920
Mailing Address - Country:US
Mailing Address - Phone:252-438-4426
Mailing Address - Fax:
Practice Address - Street 1:451 RUIN CREEK RD STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5920
Practice Address - Country:US
Practice Address - Phone:252-438-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0146UOtherBLUE CROSS BLUE SHIELD
NC0497070001Medicare NSC