Provider Demographics
NPI:1104905371
Name:GUILFORD FOOT CENTER PA
Entity type:Organization
Organization Name:GUILFORD FOOT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-282-8787
Mailing Address - Street 1:3931 TINSLEY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1532
Mailing Address - Country:US
Mailing Address - Phone:336-282-8787
Mailing Address - Fax:336-510-7284
Practice Address - Street 1:3931 TINSLEY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1532
Practice Address - Country:US
Practice Address - Phone:336-282-8787
Practice Address - Fax:336-510-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233213ER0200X, 213ES0131X
NCNC233213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890808WMedicaid
NC2326409AMedicare PIN
NC0916630001Medicare NSC