Provider Demographics
NPI:1316229511
Name:SALISBURY FOOT & ANKLE CENTER, PA
Entity Type:Organization
Organization Name:SALISBURY FOOT & ANKLE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-636-7575
Mailing Address - Street 1:217 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3325
Mailing Address - Country:US
Mailing Address - Phone:704-636-7575
Mailing Address - Fax:
Practice Address - Street 1:217 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3325
Practice Address - Country:US
Practice Address - Phone:704-636-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309213ES0103X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890810JMedicaid
NC2432146CMedicare PIN
NCT80549Medicare UPIN