Provider Demographics
NPI:1336327659
Name:ANKLE & FOOT CENTER OF CHARLOTTE PLLC
Entity Type:Organization
Organization Name:ANKLE & FOOT CENTER OF CHARLOTTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-541-3668
Mailing Address - Street 1:12610 N COMMUNITY HOUSE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-541-3668
Mailing Address - Fax:704-541-3622
Practice Address - Street 1:12610 N COMMUNITY HOUSE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-541-3668
Practice Address - Fax:704-541-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC433261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2433613COtherMEDICARE ID
NC890804JMedicaid
NC6148320001Medicare NSC
NC890804JMedicaid