Provider Demographics
NPI:1174751960
Name:UNIFOUR PODIATRY, PLLC
Entity type:Organization
Organization Name:UNIFOUR PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GROGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:828-267-1916
Mailing Address - Street 1:912 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3851
Mailing Address - Country:US
Mailing Address - Phone:828-267-1916
Mailing Address - Fax:828-267-1922
Practice Address - Street 1:912 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3851
Practice Address - Country:US
Practice Address - Phone:828-267-1916
Practice Address - Fax:828-267-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC430213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2030547002OtherCIGNA
NC890804EMedicaid
NC0804EOtherBC BS
NC26-42566OtherUHC
NC26-42566OtherUHC