Provider Demographics
NPI:1578785960
Name:PIEDMONT FOOT & ANKLE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PIEDMONT FOOT & ANKLE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THURMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:SICELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-751-9120
Mailing Address - Street 1:2825 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4146
Mailing Address - Country:US
Mailing Address - Phone:919-751-9120
Mailing Address - Fax:
Practice Address - Street 1:100 CHATHAM MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2445
Practice Address - Country:US
Practice Address - Phone:919-751-9120
Practice Address - Fax:919-751-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN NUMBER