Healthcare Provider Details

I. General information

NPI: 1922342062
Provider Name (Legal Business Name): INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MOCKSVILLE AVE
SALISBURY NC
28144-3328
US

IV. Provider business mailing address

1022 LEE ANN DR NE
CONCORD NC
28025-2911
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-7015
  • Fax: 704-636-9788
Mailing address:
  • Phone: 704-886-1918
  • Fax: 704-257-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number276
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number276
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number276
License Number StateNC

VIII. Authorized Official

Name: KEVIN C MCDONALD
Title or Position: PRESIDENT
Credential:
Phone: 704-786-4482