Provider Demographics
NPI:1790873503
Name:FOOT & ANKLE ASSOCIATES OF NORTH CAROLINA, PLLC
Entity Type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES OF NORTH CAROLINA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-231-7969
Mailing Address - Street 1:PO BOX 14759
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4759
Mailing Address - Country:US
Mailing Address - Phone:919-231-7969
Mailing Address - Fax:919-231-7970
Practice Address - Street 1:740 SUTTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8429
Practice Address - Country:US
Practice Address - Phone:252-451-4040
Practice Address - Fax:252-451-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCK8360OtherPALMETTO GBA-RAILROAD ME
NC0809WOtherBLUE CROSS BLUE SHEILD GP
NC690187EMedicaid
NC2331827Medicare ID - Type UnspecifiedGROUP
NC0809WOtherBLUE CROSS BLUE SHEILD GP
NCCK8360OtherPALMETTO GBA-RAILROAD ME
NC4748910002Medicare NSC
NC4748910001Medicare NSC