Provider Demographics
NPI:1336210921
Name:PIEDMONT FOOT AND ANKLE ASSOCIATES, P. C.
Entity type:Organization
Organization Name:PIEDMONT FOOT AND ANKLE ASSOCIATES, P. C.
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:ERIC
Authorized Official - Last Name:SICELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-835-7676
Mailing Address - Street 1:2825 LYNDHURST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4146
Mailing Address - Country:US
Mailing Address - Phone:336-768-3305
Mailing Address - Fax:336-768-3350
Practice Address - Street 1:680 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2487
Practice Address - Country:US
Practice Address - Phone:336-835-7676
Practice Address - Fax:336-835-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC388213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherFEDERAL TAX ID