Provider Demographics
NPI:1568113132
Name:ELDRIDGE PODIATRY PA
Entity Type:Organization
Organization Name:ELDRIDGE PODIATRY PA
Other - Org Name:CAROLINA FOOT & ANKLE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-304-0400
Mailing Address - Street 1:1501 TATE BLVD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1385
Mailing Address - Country:US
Mailing Address - Phone:828-304-0400
Mailing Address - Fax:828-304-0142
Practice Address - Street 1:1501 TATE BLVD SE STE 203
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1385
Practice Address - Country:US
Practice Address - Phone:828-304-0400
Practice Address - Fax:828-304-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty