Provider Demographics
NPI:1891879334
Name:THE SPRINGWOOD PODIATRY GROUP, A PROFESIONAL CORPORATION
Entity Type:Organization
Organization Name:THE SPRINGWOOD PODIATRY GROUP, A PROFESIONAL CORPORATION
Other - Org Name:SPRINGWOOD PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:951-652-4386
Mailing Address - Street 1:255 N GILBERT ST
Mailing Address - Street 2:STE B-1
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4066
Mailing Address - Country:US
Mailing Address - Phone:951-652-4386
Mailing Address - Fax:951-925-4947
Practice Address - Street 1:255 N GILBERT ST
Practice Address - Street 2:STE B-1
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4066
Practice Address - Country:US
Practice Address - Phone:951-652-4386
Practice Address - Fax:951-925-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ85609ZMedicare PIN
CA0452660001Medicare NSC