Provider Demographics
NPI:1962673640
Name:UWHARRIE PODIATRY, LLC
Entity Type:Organization
Organization Name:UWHARRIE PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-983-5763
Mailing Address - Street 1:143 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4901
Mailing Address - Country:US
Mailing Address - Phone:704-983-5763
Mailing Address - Fax:704-983-5642
Practice Address - Street 1:143 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4901
Practice Address - Country:US
Practice Address - Phone:704-983-5763
Practice Address - Fax:704-983-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08125OtherBCBS
NC243063COtherPTAN
NC8908125Medicaid
NC243063COtherPTAN
NC8908125Medicaid
NC08125OtherBCBS