Provider Demographics
NPI:1659561850
Name:FOOT AND ANKLE SPECIALISTS PA
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:PLUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-686-0040
Mailing Address - Street 1:7946 MARKET ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8750
Mailing Address - Country:US
Mailing Address - Phone:910-686-0040
Mailing Address - Fax:
Practice Address - Street 1:7946 MARKET ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8750
Practice Address - Country:US
Practice Address - Phone:910-686-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2578620Medicare PIN
NC5936830001Medicare NSC