1538345194 NPI number — FOOT CARE ASSOCIATES PC

Table of content: (NPI 1538345194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538345194 NPI number — FOOT CARE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT CARE ASSOCIATES PC
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:
JOHN H BRUNSMAN
Provider Other Organization Name Type Code:
4
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:
1538345194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2032
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98073-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-885-7004
Provider Business Mailing Address Fax Number:
425-885-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14692 179TH AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-794-1266
Provider Business Practice Location Address Fax Number:
425-885-7004
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNSMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
360-794-1266

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  246 , 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: 480015164 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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