Alta Ridge Foot Specialists, PLLC
Organization Active NPI Podiatrist · Boone, NC
NPI 1124414545 · NPPES record last updated Jan 10, 2020
Key facts
- NPI
- 1124414545
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- ALTA RIDGE FOOT SPECIALISTS, PLLC
- Practice address
- 2211 Highway 105
Boone, NC 28607-7813 - Phone
- (828) 286-1948
- Fax
- (828) 286-1951
- NPI assigned
- Apr 13, 2015
- Organization subpart
- No
Authorized official
- Name
- Robert L Van Brederode, DPM
- Title
- Owner/Provider
- Phone
- (828) 766-7667
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 1
Practitioners 4
-
William Aaron Broyles, D.P.M.
-
Thomas D Verla, D.P.M.
-
Samantha J Price, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200124000264 | NC | DME Supplier - Physician - General Practice | 2163571258 | Practice locations: Boone, NC |
National Provider Directory
- Tax ID family
- Alta Ridge Foot Specialists PLLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes | ||
| Foot & Ankle Surgery Podiatrist |
213ES0103X | |||
| Foot Surgery Podiatrist |
213ES0131X |
Addresses
Primary practice location
2211 Highway 105
Boone, NC 28607-7813
Mailing address
440 Altapass Hwy
Spruce Pine, NC 28777-3011
Phone (828) 766-7667
Other providers in Boone, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.