Provider Demographics
NPI:1073911046
Name:SEATTLE FOOT AND ANKLE WELLNESS CENTER
Entity Type:Organization
Organization Name:SEATTLE FOOT AND ANKLE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-962-9229
Mailing Address - Street 1:3225 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3304
Mailing Address - Country:US
Mailing Address - Phone:206-607-6709
Mailing Address - Fax:206-508-9090
Practice Address - Street 1:3225 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3304
Practice Address - Country:US
Practice Address - Phone:206-607-6709
Practice Address - Fax:206-508-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60482833213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA277210WMSMedicare PIN
PA1028360090001Medicaid