Provider Demographics
NPI:1073797551
Name:COLUMBIA FOOT HEALTH CLINIC PS
Entity Type:Organization
Organization Name:COLUMBIA FOOT HEALTH CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIAN
Authorized Official - Middle Name:JERALD
Authorized Official - Last Name:VANGORKUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-946-7602
Mailing Address - Street 1:925 STEVENS DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3523
Mailing Address - Country:US
Mailing Address - Phone:509-946-7602
Mailing Address - Fax:509-943-9389
Practice Address - Street 1:925 STEVENS DR STE 2D
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3523
Practice Address - Country:US
Practice Address - Phone:509-946-7602
Practice Address - Fax:509-943-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000620213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7090251Medicaid
WAU64933Medicare UPIN
WA319210400Medicare PIN
WA0480830001Medicare NSC