Provider Demographics
NPI:1942371919
Name:EBERHARDT FOOT & ANKLE CLINIC
Entity type:Organization
Organization Name:EBERHARDT FOOT & ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-776-0300
Mailing Address - Street 1:111 DENNIS DR STE 123
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6461
Mailing Address - Country:US
Mailing Address - Phone:919-776-0300
Mailing Address - Fax:919-776-0511
Practice Address - Street 1:111 DENNIS DR STE 123
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6461
Practice Address - Country:US
Practice Address - Phone:919-776-0300
Practice Address - Fax:919-776-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332213ES0103X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0297LOtherBCBS
NC890806KMedicaid
2336170OtherMEDICARE LEGACY NUMBER
NC890297LMedicaid
NC0297LOtherBC/BS NC
2336170Medicare Oscar/Certification
NC0297LOtherBCBS
2336170Medicare PIN