Provider Demographics
NPI:1114944865
Name:S SOUND FOOT & ANKLE INC PS
Entity Type:Organization
Organization Name:S SOUND FOOT & ANKLE INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HORSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-456-3171
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE L
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-456-3171
Mailing Address - Fax:360-456-2597
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE L
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-456-3171
Practice Address - Fax:360-456-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206100001OtherDMERC
WA1011626Medicaid
WA480006043OtherRR MEDICARE
WA50D0636887OtherCLIA
WA50D0636887OtherCLIA
WA0206100001Medicare NSC
WA480006043OtherRR MEDICARE
WA1114944865Medicare UPIN