Provider Demographics
NPI:1154371391
Name:FOOT AND ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREENAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-248-3668
Mailing Address - Street 1:17820 1ST AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1794
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:17820 1ST AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1794
Practice Address - Country:US
Practice Address - Phone:206-248-3668
Practice Address - Fax:206-244-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5823620001OtherDME SUPPLIER NUMBER
WA7132327Medicaid
WADE6917OtherRR MEDICARE
WAG8860009Medicare PIN
WA5823620001Medicare NSC