Provider Demographics
NPI:1629254339
Name:ALPINE FOOT & ANKLE CLINIC, PS
Entity Type:Organization
Organization Name:ALPINE FOOT & ANKLE CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-653-2326
Mailing Address - Street 1:17432 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6363
Mailing Address - Country:US
Mailing Address - Phone:360-653-2326
Mailing Address - Fax:360-658-8944
Practice Address - Street 1:17432 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6363
Practice Address - Country:US
Practice Address - Phone:360-653-2326
Practice Address - Fax:360-658-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO676213ES0103X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7111271Medicaid
WA7111271Medicaid
WA4457470001Medicare NSC
WAAB26758Medicare PIN