Healthcare Provider Details

I. General information

NPI: 1699863027
Provider Name (Legal Business Name): FOOT AND ANKLE OF THE CAROLINAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 SENNA DR
MATTHEWS NC
28105-6722
US

IV. Provider business mailing address

2950 SENNA DR
MATTHEWS NC
28105-6722
US

V. Phone/Fax

Practice location:
  • Phone: 704-845-2920
  • Fax: 704-845-2921
Mailing address:
  • Phone: 704-845-2920
  • Fax: 704-845-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number259
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier89012J7
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier012J7
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS GROUP
# 3
Identifier340515
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMAMSI
# 4
Identifier463679
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerANTHEM

VIII. Authorized Official

Name: DR. ERIC V WARD
Title or Position: MANAGER
Credential: DPM
Phone: 704-845-2920