Basic Information
Provider Information
NPI: 1922470624
EntityType: 2
ReplacementNPI:  
OrganizationName: INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1190 HIGHWAY 9 BYP W
Address2:  
City: LANCASTER
State: SC
PostalCode: 297201709
CountryCode: US
TelephoneNumber: 8032851411
FaxNumber:  
Practice Location
Address1: 6237 CAROLINA COMMONS DR STE 310
Address2:  
City: INDIAN LAND
State: SC
PostalCode: 297076071
CountryCode: US
TelephoneNumber: 8035483338
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/21/2015
LastUpdateDate: 06/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PERCIVAL
AuthorizedOfficialFirstName: BRANDON
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 8032851411
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DPM
NPICertificationDate: 06/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0131X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
213E00000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPPodiatric Medicine & Surgery Service ProvidersPodiatrist 

No ID Information.


Home