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General NPI Number Information
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NPI Number | 1134466113
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Entity Type | Organization
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Legal Business Name | INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 710 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-3406
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Country | US
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Telephone | 704-636-7015
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Fax | 704-636-9788
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | HARRISBURG
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State | NC
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Zip | 28075-1060
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Country | US
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Telephone | 704-886-1918
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN C MCDONALD
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Credential | DPM
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Telephone | 704-886-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 276
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 276
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 276
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License Number State | NC
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