Provider Demographics
NPI:1164720462
Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:ENUMCLAW FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-449-2471
Mailing Address - Street 1:2728 E MAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-841-2006
Mailing Address - Fax:253-840-6691
Practice Address - Street 1:2820 GRIFFIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-825-2181
Practice Address - Fax:360-825-8354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906903Medicare PIN
WA6682130003Medicare NSC