1902167471 NPI number — ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS

Table of content: (NPI 1902167471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902167471 NPI number — ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
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:
1902167471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2728 E MAIN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-644-2313
Provider Business Mailing Address Fax Number:
425-644-4739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18100 NE UNION HILL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-2313
Provider Business Practice Location Address Fax Number:
425-644-4739
Provider Enumeration Date:
05/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHU
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
425-449-2471

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO00000277 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO00000277 , 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)





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