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General NPI Number Information
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NPI Number | 1710225669
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE INSTITUTE OF NC
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 533 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-872-2028
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Fax | 704-872-3390
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Provider Business Mailing Address
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Address Line | PO BOX 24561
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City | WINSTON SALEM
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State | NC
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Zip | 27114-4561
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Country | US
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Telephone | 336-618-6961
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Fax | 336-793-3051
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Authorized Official
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Title or Position | PODIATRIST
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Name | GEORGE VITO
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Credential | DPM
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Telephone | 336-618-6961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 330
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License Number State | NC
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