Provider Demographics
NPI:1942314802
Name:PIEDMONT FOOT AND ANKLE ASSOCIATES PC
Entity Type:Organization
Organization Name:PIEDMONT FOOT AND ANKLE ASSOCIATES PC
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 1:3641 WESTGATE CENTER CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2936
Mailing Address - Country:US
Mailing Address - Phone:919-751-9120
Mailing Address - Fax:919-751-9170
Practice Address - Street 1:3641 WESTGATE CENTER CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2936
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:2006-08-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN NUMBER
NC5807500005Medicare NSC
NC2328324Medicare PIN