MEDICARE: INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	276	NC
2	213ES0131X	Foot Surgery Podiatrist	276	NC
3	213EP1101X	Primary Podiatric Medicine Podiatrist	276	NC

General Provider Information

NPI Number	:	1922342062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	1022 LEE ANN DR NE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2911
Country	:	US
Telephone Number	:	704-886-1918
Fax Number	:	704-257-2049

Provider Business Practice Location Address
First Line	:	322 MOCKSVILLE AVE
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28144-3328
Country	:	US
Telephone Number	:	704-636-7015
Fax Number	:	704-636-9788

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN C MCDONALD
Credential	:
Telephone Number	:	704-786-4482

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	02/21/2017

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