Provider Demographics
NPI:1316993033
Name:SPRINKLE FOOT & ANKLE CENTER PA
Entity type:Organization
Organization Name:SPRINKLE FOOT & ANKLE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-765-8637
Mailing Address - Street 1:751 BETHESDA ROAD
Mailing Address - Street 2:SPRINKLE FOOT AND ANKLE CENTER PA STE 102
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-8637
Mailing Address - Fax:336-765-7868
Practice Address - Street 1:751 BETHESDA ROAD
Practice Address - Street 2:SPRINKLE FOOT AND ANKLE CENTER PA STE 102
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-8637
Practice Address - Fax:336-765-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908163Medicaid
243129Medicare ID - Type Unspecified
NC7908163Medicaid