Provider Demographics
NPI:1821273921
Name:SYLVIA A THOMPSON
Entity Type:Organization
Organization Name:SYLVIA A THOMPSON
Other - Org Name:WELL FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, RN
Authorized Official - Phone:360-582-3736
Mailing Address - Street 1:409 S OAK STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6246
Mailing Address - Country:US
Mailing Address - Phone:360-582-3736
Mailing Address - Fax:877-582-3735
Practice Address - Street 1:409 S OAK ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6246
Practice Address - Country:US
Practice Address - Phone:360-582-3736
Practice Address - Fax:877-582-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6122870001Medicare NSC