Provider Demographics
NPI:1700051497
Name:CHELAN-OKANOGAN FOOT & ANKLE
Entity Type:Organization
Organization Name:CHELAN-OKANOGAN FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORLEBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-682-0232
Mailing Address - Street 1:503 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8631
Mailing Address - Country:US
Mailing Address - Phone:509-682-3300
Mailing Address - Fax:509-682-6131
Practice Address - Street 1:503 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8631
Practice Address - Country:US
Practice Address - Phone:509-682-3300
Practice Address - Fax:509-682-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP0694213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7104128Medicaid
WA4844668OtherDME
4266020001OtherDMERC
WA0146103OtherL&I
WAG8851326Medicare PIN
4266020001OtherDMERC
WA7104128Medicaid