Provider Demographics
NPI:1609065713
Name:ALDERWOOD ANKLE & FOOT CLINIC P.S.
Entity Type:Organization
Organization Name:ALDERWOOD ANKLE & FOOT CLINIC P.S.
Other - Org Name:LAKE STEVENS ANKLE & FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-778-5666
Mailing Address - Street 1:3500 188TH ST SW STE 110
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4757
Mailing Address - Country:US
Mailing Address - Phone:425-778-5666
Mailing Address - Fax:425-771-5374
Practice Address - Street 1:3500 188TH ST SW STE 110
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4757
Practice Address - Country:US
Practice Address - Phone:425-778-5666
Practice Address - Fax:425-771-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000346261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27172Medicare PIN
WA4617710001Medicare NSC