1316993033 NPI number — SPRINKLE FOOT & ANKLE CENTER PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316993033 NPI number — SPRINKLE FOOT & ANKLE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINKLE FOOT & ANKLE CENTER PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316993033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 BETHESDA ROAD
Provider Second Line Business Mailing Address:
SPRINKLE FOOT AND ANKLE CENTER PA STE 102
Provider Business Mailing Address City Name:
WINSTON-SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-765-8637
Provider Business Mailing Address Fax Number:
336-765-7868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 BETHESDA ROAD
Provider Second Line Business Practice Location Address:
SPRINKLE FOOT AND ANKLE CENTER PA STE 102
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-765-8637
Provider Business Practice Location Address Fax Number:
336-765-7868
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRINKLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER CEO
Authorized Official Telephone Number:
336-765-8637

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  215 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7908163 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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