Provider Demographics
NPI:1023185055
Name:CLACKAMAS FOOT & ANKLE CLINIC, INC.
Entity Type:Organization
Organization Name:CLACKAMAS FOOT & ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY-TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-652-9671
Mailing Address - Street 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 105N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-652-9671
Mailing Address - Fax:
Practice Address - Street 1:8800 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 105N
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5738
Practice Address - Country:US
Practice Address - Phone:503-652-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00267213E00000X, 213ES0131X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDE4383OtherMEDICARE RAILROAD - GBA
OR480019925OtherMEDICARE RAILROAD GBA
OR5863210002Medicare NSC
OR480019925OtherMEDICARE RAILROAD GBA