1154371391 NPI number — FOOT AND ANKLE SPECIALISTS, PLLC

Table of content: (NPI 1154371391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154371391 NPI number — FOOT AND ANKLE SPECIALISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SPECIALISTS, PLLC
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:
1154371391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17820 1ST AVE S
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98148-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-592-5000
Provider Business Mailing Address Fax Number:
206-824-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17820 1ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-248-3668
Provider Business Practice Location Address Fax Number:
206-244-2499
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREENAN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MBR/ OWNER
Authorized Official Telephone Number:
206-248-3668

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5823620001 . This is a "DME SUPPLIER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7132327 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE6917 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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