Provider Demographics
NPI:1609998004
Name:FAMILY FOOT CARE, P.S.
Entity Type:Organization
Organization Name:FAMILY FOOT CARE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-738-9797
Mailing Address - Street 1:234 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6540
Mailing Address - Country:US
Mailing Address - Phone:360-738-9797
Mailing Address - Fax:
Practice Address - Street 1:234 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6540
Practice Address - Country:US
Practice Address - Phone:360-738-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000490213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1078096Medicaid
WA8854471Medicare ID - Type Unspecified
WA1078096Medicaid
WA6186240001Medicare NSC