Provider Demographics
NPI:1093836652
Name:NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
Entity Type:Organization
Organization Name:NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
Other - Org Name:ACTIVE FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-1505
Mailing Address - Street 1:21229 84TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7304
Mailing Address - Country:US
Mailing Address - Phone:425-775-1505
Mailing Address - Fax:425-775-9078
Practice Address - Street 1:1545 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6800
Practice Address - Country:US
Practice Address - Phone:206-528-0100
Practice Address - Fax:206-528-2112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST FOOT AND ANKLE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50-C0001166OtherSTATE CERTIFICATION NUMBER
WAU39356Medicare UPIN
WAG8865834Medicare PIN