Provider Demographics
NPI:1952611543
Name:FAMILY FOOT AND ANKLE PHYSICIANS PLLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE PHYSICIANS PLLC
Other - Org Name:FAMILY FOOT AND ANKLE PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-439-1150
Mailing Address - Street 1:1432 E. FIRETOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4105
Mailing Address - Country:US
Mailing Address - Phone:252-439-1150
Mailing Address - Fax:252-439-1152
Practice Address - Street 1:1432 E. FIRETOWER ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4105
Practice Address - Country:US
Practice Address - Phone:252-439-1150
Practice Address - Fax:252-439-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
NC412213E00000X
NC537213E00000X, 213ES0103X
NC581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6520750001Medicare NSC
2348076Medicare PIN