Provider Demographics
NPI:1073393260
Name:COLUMBIA FOOT AND ANKLE CLINIC, LLC
Entity Type:Organization
Organization Name:COLUMBIA FOOT AND ANKLE CLINIC, LLC
Other - Org Name:COLUMBIA FOOT AND ANKLE CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:949-664-2796
Mailing Address - Street 1:12411 NE 70TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-4885
Mailing Address - Country:US
Mailing Address - Phone:602-615-9915
Mailing Address - Fax:
Practice Address - Street 1:12411 NE 70TH CIR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-4885
Practice Address - Country:US
Practice Address - Phone:602-615-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1265164198OtherNPI
WA2228399Medicaid
OR500823690Medicaid