Provider Demographics
NPI:1740378496
Name:FOOT AND ANKLE CENTER OF THE CAROLINAS, PA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF THE CAROLINAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-245-6405
Mailing Address - Street 1:247 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-6958
Mailing Address - Country:US
Mailing Address - Phone:828-245-6405
Mailing Address - Fax:828-245-3923
Practice Address - Street 1:247 SHILOH RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-6958
Practice Address - Country:US
Practice Address - Phone:828-245-6405
Practice Address - Fax:828-245-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC422213E00000X
NC4387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0184NOtherBCBS
NC0184NOtherBCBS
NC2345705Medicare ID - Type Unspecified