Provider Demographics
NPI:1790039154
Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:COMPREHENSIVE FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-332-5115
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:6602 ROBERTA ROAD
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-1060
Mailing Address - Country:US
Mailing Address - Phone:704-332-5115
Mailing Address - Fax:704-332-5116
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 503
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-332-5115
Practice Address - Fax:704-332-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC413213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790801YMedicaid
NC6712460015Medicare NSC
NC790801YMedicaid
NCNCA023Medicare PIN