Provider Demographics
NPI:1235443334
Name:FOOTHILLS INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:FOOTHILLS INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-825-8900
Mailing Address - Street 1:2820 GRIFFIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:360-825-8900
Mailing Address - Fax:
Practice Address - Street 1:2820 GRIFFIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-825-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603032697261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care