Provider Demographics
NPI:1730154584
Name:ANKLE & FOOT CLINICS NORTHWEST, PS
Entity type:Organization
Organization Name:ANKLE & FOOT CLINICS NORTHWEST, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-327-6603
Mailing Address - Street 1:4924 CHINOOK DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1376
Mailing Address - Country:US
Mailing Address - Phone:425-327-6603
Mailing Address - Fax:
Practice Address - Street 1:4924 CHINOOK DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1376
Practice Address - Country:US
Practice Address - Phone:425-327-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089964Medicaid
WAAN0085OtherREGENCE
WA69527OtherLABOR & INDUSTRIES
WA0207620002Medicare NSC
WAG001255700Medicare PIN
WACH1937Medicare PIN