Provider Demographics
NPI:1043629652
Name:THOMPSON FOOT AND ANKLE CLINIC INC
Entity Type:Organization
Organization Name:THOMPSON FOOT AND ANKLE CLINIC INC
Other - Org Name:THOMPSON FOOT AND ANKLE CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:ANTHON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-838-5010
Mailing Address - Street 1:2317 SW 320TH ST
Mailing Address - Street 2:700
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2567
Mailing Address - Country:US
Mailing Address - Phone:253-838-5010
Mailing Address - Fax:253-838-5280
Practice Address - Street 1:2317 SW 320TH ST
Practice Address - Street 2:700
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2567
Practice Address - Country:US
Practice Address - Phone:253-838-5010
Practice Address - Fax:253-838-5280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMPSON FOOT AND ANKLE CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000238261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1258003Medicaid
WAT01863Medicare UPIN
WA1258003Medicaid