Provider Demographics
NPI:1669417465
Name:FOOT CARE SPECIALIST , PLLC
Entity type:Organization
Organization Name:FOOT CARE SPECIALIST , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAILE RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-557-0300
Mailing Address - Street 1:1140 HOLLY SPRINGS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9634
Mailing Address - Country:US
Mailing Address - Phone:919-342-7094
Mailing Address - Fax:919-400-4355
Practice Address - Street 1:1140 HOLLY SPRINGS
Practice Address - Street 2:SUITE 107
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7584
Practice Address - Country:US
Practice Address - Phone:919-557-0300
Practice Address - Fax:919-567-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC480213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903259Medicaid
NC2402749AMedicare PIN
NCVO6576Medicare UPIN
NC5697870001Medicare NSC
NC2324300Medicare PIN