Provider Demographics
NPI:1740478130
Name:BURLINGTON FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:BURLINGTON FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PETERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-226-9919
Mailing Address - Street 1:428 ALAMANCE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5500
Mailing Address - Country:US
Mailing Address - Phone:336-226-9919
Mailing Address - Fax:336-226-9959
Practice Address - Street 1:428 ALAMANCE RD STE C
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5500
Practice Address - Country:US
Practice Address - Phone:336-226-9919
Practice Address - Fax:336-226-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC409213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2433228BOtherMEDICARE GROUP PIN
NC790213WMedicaid
NC890801UMedicaid
NC790213WMedicaid
4746260001Medicare NSC