Provider Demographics
NPI:1649561168
Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:ANKLE & FOOT SPECIALIST OF PUYALLUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ 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 STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-848-6656
Mailing Address - Fax:253-840-6787
Practice Address - Street 1:3908 10TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-6656
Practice Address - Fax:253-840-6787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-02
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 60106729213E00000X, 213ES0103X
WAPO 30106729213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906838Medicare PIN