Provider Demographics
NPI:1558668582
Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:
Other - Org Type:
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 1:2728 E MAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3198
Practice Address - Country:US
Practice Address - Phone:253-841-2006
Practice Address - Fax:253-840-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6682130001Medicare NSC
WA6682130003Medicare NSC
WAG8906844Medicare PIN
WAG8906845Medicare PIN
WAG8906842Medicare PIN
WAG8906843Medicare PIN
WA6682130002Medicare NSC
WAG8906852Medicare PIN
WAG8906903Medicare PIN
WAG8911166Medicare PIN
WAG8906838Medicare PIN