NPIMap

Organization Active NPI

Queen City Foot and Ankle Specialists

  • Specialist
  • Charlotte, NC
National Provider Identifier
1629048566
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
461 Issued in NC
Legal business name
QUEEN CITY FOOT AND ANKLE SPECIALISTS
Practice address
11030 S Tryon St
Suite 308
Charlotte, NC 28273-6530
Phone
(704) 504-1004
Fax
(704) 504-0007
NPI assigned
Jan 24, 2006
Last updated
Sep 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Roxanne Burgess, D.P.M.NPI 1457533473
Title
Owner
Phone
(704) 504-1004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 461 NC Primary

Addresses

Primary practice location

11030 S Tryon St
Suite 308
Charlotte, NC 28273-6530

Mailing address

11030 S Tryon St
Suite 308
Charlotte, NC 28273-6530
Phone (704) 504-1004

Other identifiers 1

IdentifierTypeStateIssuer
89081AVMedicaidNC

National Provider Directory

National Provider Directory

Locations

13209 Carowinds Blvd
Ste K
Charlotte, NC 28273
Phone (704) 504-1004

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1629048566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11030 S TRYON ST",
            "address_2": "SUITE 308",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282736530",
            "telephone_number": "704-504-1004",
            "fax_number": "704-504-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11030 S TRYON ST",
            "address_2": "SUITE 308",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282736530",
            "telephone_number": "704-504-1004",
            "fax_number": "704-504-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN CITY FOOT AND ANKLE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-504-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89081AV",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.