Basic Information
| Provider Information | |||||||||
| NPI: | 1811139017 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PODIATRY OFFICES OF DR. MILTON RICHARDSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1031 W WILLIAMS ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275023955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193633310 | ||||||||
| FaxNumber: | 9193633370 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 W WILLIAMS ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275023955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193633310 | ||||||||
| FaxNumber: | 9193633370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 06/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | MILTON | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9193633310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MILTON W. RICHARDSON DPM | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 308 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0814N | 01 | BCBS | OTHER | 10920106 | 01 | CIGNA | OTHER | 26929 | 01 | WELLPATH | OTHER | 5333086 | 01 | AETNA | OTHER | 890814N | 05 | NC | MEDICAID | 2752571 | 01 | UNITED | OTHER | 81278 | 01 | MEDCOST | OTHER |