1376088963 NPI number — ANKLE AND FOOT PHYSICIANS AND SURGEONS LLC

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 1376088963 NPI number — ANKLE AND FOOT PHYSICIANS AND SURGEONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE AND FOOT PHYSICIANS AND SURGEONS LLC
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:
6
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:
1376088963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 SE 117TH AVE
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-5297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-977-7815
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 12TH ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-716-5185
Provider Business Practice Location Address Fax Number:
888-625-8659
Provider Enumeration Date:
01/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WENZEL
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
541-716-5185

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)





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