Healthcare Provider Details

I. General information

NPI: 1992833594
Provider Name (Legal Business Name): NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21229 84TH AVE W
EDMONDS WA
98026-7304
US

IV. Provider business mailing address

21229 84TH AVE W
EDMONDS WA
98026-7304
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-1505
  • Fax: 425-775-9078
Mailing address:
  • Phone: 425-775-1505
  • Fax: 425-775-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO0000489
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPO0000489
License Number StateWA

VIII. Authorized Official

Name: CHERYL ANN MOORE
Title or Position: BILLING MANAGER
Credential:
Phone: 425-775-1505