MEDICARE: INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist
2	213ER0200X	Radiology Podiatrist
3	213ES0103X	Foot & Ankle Surgery Podiatrist
4	213ES0131X	Foot Surgery Podiatrist
5	213EP1101X	Primary Podiatric Medicine Podiatrist	443	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457601601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	1036 BRANCHVIEW DR STE 216
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-0113
Country	:	US
Telephone Number	:	48-861-9187
Fax Number	:	704-257-2049

Provider Business Practice Location Address
First Line	:	130 LAKE CONCORD RD NE STE B
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-1906
Country	:	US
Telephone Number	:	704-786-4482
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ELDON PETERS
Credential	:
Telephone Number	:	919-829-0076

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	08/20/2025

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