Basic Information
| Provider Information | |||||||||
| NPI: | 1942314802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT FOOT AND ANKLE ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3641 WESTGATE CENTER CIR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271032936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197519120 | ||||||||
| FaxNumber: | 9197519170 | ||||||||
| Practice Location | |||||||||
| Address1: | 3641 WESTGATE CENTER CIR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271032936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197519120 | ||||||||
| FaxNumber: | 9197519170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SICELOFF | ||||||||
| AuthorizedOfficialFirstName: | THURMOND | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9197519120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.