Provider Demographics
NPI:1174296354
Name:S&A PODIATRY CLINIC INC
Entity Type:Organization
Organization Name:S&A PODIATRY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SEIHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:209-425-4846
Mailing Address - Street 1:420 W ACACIA ST STE 18
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2441
Mailing Address - Country:US
Mailing Address - Phone:209-425-4846
Mailing Address - Fax:209-425-0570
Practice Address - Street 1:420 W ACACIA ST STE 18
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2441
Practice Address - Country:US
Practice Address - Phone:209-425-4846
Practice Address - Fax:209-425-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty