Healthcare Provider Details

I. General information

NPI: 1477671758
Provider Name (Legal Business Name): NORTH CASCADE FOOT CLINIC ASC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SHERIDAN RD SUITE # 104
BREMERTON WA
98310-2701
US

IV. Provider business mailing address

900 SHERIDAN RD SUITE #101
BREMERTON WA
98310-2701
US

V. Phone/Fax

Practice location:
  • Phone: 206-819-9605
  • Fax:
Mailing address:
  • Phone: 206-819-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRK D SHERRIS
Title or Position: OWNER
Credential: D.P.M.
Phone: 206-819-9605