1093836652 NPI number — NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.

Table of content: (NPI 1093836652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093836652 NPI number — NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
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:
ACTIVE FOOT & ANKLE
Provider Other Organization Name Type Code:
3
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:
1093836652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21229 84TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98026-7304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-775-1505
Provider Business Mailing Address Fax Number:
425-775-9078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 NE 65TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-528-0100
Provider Business Practice Location Address Fax Number:
206-528-2112
Provider Enumeration Date:
04/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
425-775-1505

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50-C0001166 . This is a "STATE CERTIFICATION NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".