Provider Demographics
NPI:1437144896
Name:GREENVILLE FOOT & ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:GREENVILLE FOOT & ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIVATTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-321-0203
Mailing Address - Street 1:2409 S CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5925
Mailing Address - Country:US
Mailing Address - Phone:252-321-0203
Mailing Address - Fax:252-353-5669
Practice Address - Street 1:2409 S CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5925
Practice Address - Country:US
Practice Address - Phone:252-321-0203
Practice Address - Fax:252-353-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908015Medicaid
NC08015OtherBCBS/STATE
T64082Medicare UPIN
NC7908015Medicaid
NC4930770001Medicare NSC