Provider Demographics
NPI:1962531764
Name:STEVENS FOOT & ANKLE LLP
Entity type:Organization
Organization Name:STEVENS FOOT & ANKLE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-775-6996
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:425-775-6996
Mailing Address - Fax:425-670-8905
Practice Address - Street 1:7315 212TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-775-6996
Practice Address - Fax:425-670-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPOOOOOO411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7094816Medicaid
ST5742OtherREGENCE RIDER
WA0124633OtherL AND I
CH7422OtherMEDICARE RR
ST5742OtherREGENCE RIDER
WA3914280001Medicare NSC