Provider Demographics
NPI:1508182460
Name:ANKLE AND FOOT PHYSICIANS AND SURGEONS PLLC
Entity Type:Organization
Organization Name:ANKLE AND FOOT PHYSICIANS AND SURGEONS PLLC
Other - Org Name:ANKLE AND FOOT PHYSICIANS AND SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-977-7815
Mailing Address - Street 1:601 SE 117TH AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5297
Mailing Address - Country:US
Mailing Address - Phone:360-977-7815
Mailing Address - Fax:888-568-4875
Practice Address - Street 1:601 SE 117TH AVE STE 240
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5297
Practice Address - Country:US
Practice Address - Phone:360-977-7815
Practice Address - Fax:888-568-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6406580001Medicare NSC