Provider Demographics
NPI:1376857615
Name:FOOT CARE ASSOCIATES
Entity Type:Organization
Organization Name:FOOT CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRUNSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-885-7004
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98073-2032
Mailing Address - Country:US
Mailing Address - Phone:425-885-7004
Mailing Address - Fax:425-885-0515
Practice Address - Street 1:16146 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4318
Practice Address - Country:US
Practice Address - Phone:425-885-7004
Practice Address - Fax:425-885-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60102987261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7056377Medicaid
T01540Medicare UPIN
WA7056377Medicaid