Basic Information
| Provider Information | |||||||||
| NPI: | 1689080962 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA FOOT AND ANKLE HEALTH CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51363 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277171363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196030044 | ||||||||
| FaxNumber: | 9196030151 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 PROFESSIONAL PARK | ||||||||
| Address2: | SUITE B | ||||||||
| City: | OXFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275652581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196030044 | ||||||||
| FaxNumber: | 9196030151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | MILLICENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9196030044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 562 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.