Provider Demographics
NPI:1629161179
Name:COUPEVILLE FOOT AND ANKLE CLINIC, P.S., INC.
Entity Type:Organization
Organization Name:COUPEVILLE FOOT AND ANKLE CLINIC, P.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-678-3121
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239
Mailing Address - Country:US
Mailing Address - Phone:360-678-3121
Mailing Address - Fax:360-678-3186
Practice Address - Street 1:412 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3416
Practice Address - Country:US
Practice Address - Phone:206-522-6640
Practice Address - Fax:206-527-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9082CUOtherBLUE CROSS
WA1062777Medicaid
WA1062777Medicaid
WA=========OtherTAX ID
WA9082CUOtherBLUE CROSS