Provider Demographics
NPI:1407426497
Name:BIGFOOT PODIATRY, PLLC
Entity Type:Organization
Organization Name:BIGFOOT PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-990-0716
Mailing Address - Street 1:9927 MICKELBERRY RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7861
Mailing Address - Country:US
Mailing Address - Phone:360-616-9563
Mailing Address - Fax:360-850-1423
Practice Address - Street 1:9927 MICKELBERRY RD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7861
Practice Address - Country:US
Practice Address - Phone:360-616-9563
Practice Address - Fax:360-850-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2181052Medicaid