NPIMap

Organization Active NPI

Foot & Ankle Associates of the Triad, PA

  • Podiatrist
  • Winston Salem, NC
National Provider Identifier
1063641710
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
FOOT & ANKLE ASSOCIATES OF THE TRIAD, PA
Practice address
3641 Westgate Center Cir
Suite a
Winston Salem, NC 27103-2936
Phone
(336) 774-4021
Fax
(336) 774-4024
NPI assigned
Jul 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thurmond Eric Siceloff, DPMNPI 1164425013
Title
President
Phone
(336) 774-4021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

3641 Westgate Center Cir
Suite a
Winston Salem, NC 27103-2936

Mailing address

3641 Westgate Center Cir
Suite a
Winston Salem, NC 27103-2936
Phone (336) 774-4021

Other identifiers 2

IdentifierTypeStateIssuer
021WJOtherNCBCBS
5912100MedicaidNC

National Provider Directory

National Provider Directory

Locations

3641 Westgate Center Cir
#A
Winston Salem, NC 27103
Phone (336) 774-3141

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1063641710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3641 WESTGATE CENTER CIR",
            "address_2": "SUITE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032936",
            "telephone_number": "336-774-4021",
            "fax_number": "336-774-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 WESTGATE CENTER CIR",
            "address_2": "SUITE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032936",
            "telephone_number": "336-774-4021",
            "fax_number": "336-774-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT & ANKLE ASSOCIATES OF THE TRIAD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-02",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "SICELOFF",
        "authorized_official_first_name": "THURMOND",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-774-4021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "021WJ",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912100",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.