| Organization Name: | ALTA RIDGE FOOT SPECIALISTS, PLLC |
| NPI Number: | 1386919181 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT LLOYD VAN BREDERODE (OWNER) |
| Mailing Address: | 105 Chestnut St Mars Hill |
| State: | NC US |
| Postal Code: | 287549602 |
| Phone Number: | 8286801161 |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2012 |
| NPI Last Update Date: | 03/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | 479 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |