Healthcare Provider Details

I. General information

NPI: 1588918429
Provider Name (Legal Business Name): INSTRIDE FOOT AND ANKLE SPECIALISTS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LAKE CONCORD RD NE STE B
CONCORD NC
28025-1906
US

IV. Provider business mailing address

130 LAKE CONCORD RD NE STE B
CONCORD NC
28025-1906
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-4482
  • Fax: 704-786-0604
Mailing address:
  • Phone: 704-786-4482
  • Fax: 704-786-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number443
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number443
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number443
License Number StateNC

VIII. Authorized Official

Name: ELDON PETERS
Title or Position: VICE PRESIDENT
Credential:
Phone: 919-829-0076