Provider Demographics
NPI:1902938152
Name:FOOT AND ANKLE CENTER OF DURHAM, PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF DURHAM, PC
Other - Org Name:DR RHONDA S COHEN PODIATRY ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-471-1002
Mailing Address - Street 1:3811 NORTH ROXBORO ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5800
Mailing Address - Country:US
Mailing Address - Phone:919-471-1002
Mailing Address - Fax:919-471-2638
Practice Address - Street 1:3811 NORTH ROXBORO ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-5800
Practice Address - Country:US
Practice Address - Phone:919-471-1002
Practice Address - Fax:919-471-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890278FMedicaid
0278FOtherBCBS GROUP
3990735OtherCIGNA IND
NC8908029Medicaid
NC8908029Medicaid
2432788Medicare ID - Type UnspecifiedGROUP