1114146263 NPI number — FOOT & ANKLE CENTER OF WENATCHEE, P.S.

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 1114146263 NPI number — FOOT & ANKLE CENTER OF WENATCHEE, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE CENTER OF WENATCHEE, 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:
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:
1114146263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 N CHELAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-662-2970
Provider Business Mailing Address Fax Number:
509-665-9808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 N CHELAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-662-2970
Provider Business Practice Location Address Fax Number:
509-665-9808
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEASLEY
Authorized Official First Name:
YESSICA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ASSISTANT MANAGER
Authorized Official Telephone Number:
509-662-2970

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  600366213 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 600366213 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 600366213 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7185101 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS9149 . This is a "PROF GROUP # FOR RR MEDIC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 35677 . This is a "PROF GROUP # FOR L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com