Provider Demographics
NPI:1114146263
Name:FOOT & ANKLE CENTER OF WENATCHEE, P.S.
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF WENATCHEE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YESSICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-662-2970
Mailing Address - Street 1:616 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2025
Mailing Address - Country:US
Mailing Address - Phone:509-662-2970
Mailing Address - Fax:509-665-9808
Practice Address - Street 1:616 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2025
Practice Address - Country:US
Practice Address - Phone:509-662-2970
Practice Address - Fax:509-665-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600366213213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7185101Medicaid
WACS9149OtherPROF GROUP # FOR RR MEDIC
WA35677OtherPROF GROUP # FOR L&I
WAGAB11090Medicare ID - Type UnspecifiedPROF GROUP # FOR MEDICARE
WA7185101Medicaid