Basic Information
| Provider Information | |||||||||
| NPI: | 1447228689 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE FOOT SURGERY CENTER OF NORTH CAROLINA | ||||||||
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| OtherOrganizationName: | PIEDMONT SURGICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7819 NATIONAL SERVICE ROAD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274099401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366640333 | ||||||||
| FaxNumber: | 3366640447 | ||||||||
| Practice Location | |||||||||
| Address1: | 7819 NATIONAL SERVICE ROAD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274099401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366640333 | ||||||||
| FaxNumber: | 3366640447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | COSGROVE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3364204658 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0131X | AS0063 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3409906 | 05 | NC | MEDICAID |