MEDICARE: PIEDMONT FOOT AND ANKLE ASSOCIATES, P. C.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	388	NC

General Provider Information

NPI Number	:	1336210921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT FOOT AND ANKLE ASSOCIATES, P. C.

Provider Business Mailing Address
First Line	:	2825 LYNDHURST AVE
Second Line	:	SUITE 105
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4146
Country	:	US
Telephone Number	:	336-768-3305
Fax Number	:	336-768-3350

Provider Business Practice Location Address
First Line	:	680 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2487
Country	:	US
Telephone Number	:	336-835-7676
Fax Number	:	336-835-7209

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. THURMOND ERIC SICELOFF
Credential	:	DPM
Telephone Number	:	336-835-7676

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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