Provider Demographics
NPI:1013215342
Name:BELLEVUE PODIATRY INC.
Entity Type:Organization
Organization Name:BELLEVUE PODIATRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SAAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-450-0565
Mailing Address - Street 1:1370 116TH AVE NE
Mailing Address - Street 2:STE. 206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3825
Mailing Address - Country:US
Mailing Address - Phone:425-450-0565
Mailing Address - Fax:425-462-1742
Practice Address - Street 1:1370 116TH AVE NE
Practice Address - Street 2:STE. 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3825
Practice Address - Country:US
Practice Address - Phone:425-450-0565
Practice Address - Fax:425-462-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000789213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030996Medicaid
WA1030996Medicaid