Provider Demographics
NPI:1881643419
Name:WILLIAM J ONEILL
Entity Type:Organization
Organization Name:WILLIAM J ONEILL
Other - Org Name:CAROLINA FOOT CARE ASSOC PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:B
Authorized Official - Last Name:REAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-766-8400
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0268
Mailing Address - Country:US
Mailing Address - Phone:336-766-8400
Mailing Address - Fax:336-766-8486
Practice Address - Street 1:6341 COOK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9379
Practice Address - Country:US
Practice Address - Phone:336-766-8400
Practice Address - Fax:336-766-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908042Medicaid
NC08042OtherBLUE CROSS OF NC
NC08042OtherBLUE CROSS OF NC
NC1092Medicare PIN