Healthcare Provider Details

I. General information

NPI: 1114146263
Provider Name (Legal Business Name): FOOT & ANKLE CENTER OF WENATCHEE, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 N CHELAN AVE
WENATCHEE WA
98801-2025
US

IV. Provider business mailing address

616 N CHELAN AVE
WENATCHEE WA
98801-2025
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-2970
  • Fax: 509-665-9808
Mailing address:
  • Phone: 509-662-2970
  • Fax: 509-665-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number600366213
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number600366213
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number600366213
License Number StateWA

VIII. Authorized Official

Name: YESSICA G BEASLEY
Title or Position: ASSISTANT MANAGER
Credential:
Phone: 509-662-2970