Provider Demographics
NPI:1124206115
Name:WEST SEATTLE FOOT & ANKLE CLINIC, LLC
Entity Type:Organization
Organization Name:WEST SEATTLE FOOT & ANKLE CLINIC, LLC
Other - Org Name:WEST SEATTLE FOOT & ANKLE CLINIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-937-4700
Mailing Address - Street 1:4520 42ND AVE SW
Mailing Address - Street 2:SUITE 34
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4240
Mailing Address - Country:US
Mailing Address - Phone:206-937-4700
Mailing Address - Fax:206-937-4778
Practice Address - Street 1:4520 42ND AVE SW
Practice Address - Street 2:SUITE 34
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4240
Practice Address - Country:US
Practice Address - Phone:206-937-4700
Practice Address - Fax:206-937-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000396213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT83568Medicare UPIN
WAU95373Medicare UPIN
WAT91090Medicare UPIN