Provider Demographics
NPI:1669509360
Name:ALL FOOT CARE, PA
Entity Type:Organization
Organization Name:ALL FOOT CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-766-3338
Mailing Address - Street 1:1050 S PEACE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-9788
Mailing Address - Country:US
Mailing Address - Phone:336-766-3338
Mailing Address - Fax:336-766-3990
Practice Address - Street 1:1050 S PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-9788
Practice Address - Country:US
Practice Address - Phone:336-766-3338
Practice Address - Fax:336-766-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08197OtherBLUE CROSS BLUE SHIELD
NC8908197Medicaid
243088OtherMEDICARE LEGACY NUMBER
480017385Medicare PIN
08197OtherBLUE CROSS BLUE SHIELD
5814510001Medicare NSC