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General NPI Number Information
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NPI Number | 1154747947
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Entity Type | Organization
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Legal Business Name | TRI-CITY FOOT & ANKLE CENTER, LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 9613 SANDIFUR PKWY STE B
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City | PASCO
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State | WA
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Zip | 99301-8028
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Country | US
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Telephone | 509-591-9454
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Fax | 509-578-1118
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Provider Business Mailing Address
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Address Line | 9613 SANDIFUR PKWY STE B
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City | PASCO
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State | WA
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Zip | 99301-8028
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Country | US
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Telephone | 509-591-9454
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Fax | 509-578-1118
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. BRENT JAMES THIELGES
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Credential | DPM
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Telephone | 509-591-9454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO60436994
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License Number State | WA
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