MEDICARE: ALL FOOT CARE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	243088	OTHER		MEDICARE LEGACY NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08197	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669509360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL FOOT CARE, PA

Provider Business Mailing Address
First Line	:	1050 S PEACE HAVEN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-9788
Country	:	US
Telephone Number	:	336-766-3338
Fax Number	:	336-766-3990

Provider Business Practice Location Address
First Line	:	1050 S PEACE HAVEN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-9788
Country	:	US
Telephone Number	:	336-766-3338
Fax Number	:	336-766-3990

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT C WINGATE
Credential	:	DPM
Telephone Number	:	336-766-3338

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	03/26/2019

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Directions to “ALL FOOT CARE, PA ” Practice Location

Language	Start Address	Practice Location

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