Healthcare Provider Details

I. General information

NPI: 1831956481
Provider Name (Legal Business Name): COLUMBIA FOOT AND ANKLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 NE 70TH CIR
VANCOUVER WA
98682-4885
US

IV. Provider business mailing address

1307 NE 102ND AVE STE D
PORTLAND OR
97220-3980
US

V. Phone/Fax

Practice location:
  • Phone: 949-664-2796
  • Fax:
Mailing address:
  • Phone: 949-664-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JANE HILLARY COX
Title or Position: CREDENTIALING SPECIALIST
Credential: ADMINISTRATOR
Phone: 949-664-2796