Provider Demographics
NPI:1386891109
Name:TRI CITIES FOOT & ANKLE CLINIC, PLLC
Entity type:Organization
Organization Name:TRI CITIES FOOT & ANKLE CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CALLARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-430-0334
Mailing Address - Street 1:704 W MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4127
Mailing Address - Country:US
Mailing Address - Phone:509-545-5906
Mailing Address - Fax:509-547-5999
Practice Address - Street 1:704 W MARGARET ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4127
Practice Address - Country:US
Practice Address - Phone:509-545-5906
Practice Address - Fax:509-547-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602839644261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric