Provider Demographics
NPI:1811038375
Name:CAROLINA FOOT & ANKLE OF HUNTERSVILLE, PC
Entity Type:Organization
Organization Name:CAROLINA FOOT & ANKLE OF HUNTERSVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:QUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-987-9585
Mailing Address - Street 1:16419 NORTHCROSS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5004
Mailing Address - Country:US
Mailing Address - Phone:704-987-9585
Mailing Address - Fax:704-987-9589
Practice Address - Street 1:16419 NORTHCROSS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5004
Practice Address - Country:US
Practice Address - Phone:704-987-9585
Practice Address - Fax:704-987-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC090801XMedicaid
NC090801XMedicaid
NC4557050001Medicare NSC