Healthcare Provider Details

I. General information

NPI: 1386891109
Provider Name (Legal Business Name): TRI CITIES FOOT & ANKLE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W MARGARET ST
PASCO WA
99301-4127
US

IV. Provider business mailing address

704 W MARGARET ST
PASCO WA
99301-4127
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-5906
  • Fax: 509-547-5999
Mailing address:
  • Phone: 509-545-5906
  • Fax: 509-547-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number602839644
License Number StateWA

VIII. Authorized Official

Name: DR. JAY K CALLARMAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 509-430-0334