GR Vito-Brookdale Foot Clinic

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

330 Issued in NC

Legal business name

GR VITO-BROOKDALE FOOT CLINIC

Practice address

533 Brookdale Dr
Statesville, NC 28677-4107

Phone

(336) 618-6961

NPI assigned

May 12, 2014

Last updated

May 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

George Vito

Title

Sole Member

Phone

(336) 618-6961

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1750792867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24561",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271144561",
            "telephone_number": "336-618-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774107",
            "telephone_number": "336-618-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GR VITO-BROOKDALE FOOT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "VITO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "336-618-6961"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NC",
            "license": "330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Statesville, NC
• Providers in Statesville, NC by specialty
• Foot & Ankle Surgery Podiatrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; 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.