Provider Demographics
NPI:1528127842
Name:SPRINGWOOD PODIATRY GROUP
Entity type:Organization
Organization Name:SPRINGWOOD PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
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:
Authorized Official - Phone:951-652-4386
Mailing Address - Street 1:255 N GILBERT ST
Mailing Address - Street 2:BLDG B
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:
Practice Address - Street 1:255 N GILBERT ST
Practice Address - Street 2:BLDG B
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies