Provider Demographics
NPI:1992833594
Name:NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
Entity Type:Organization
Organization Name:NORTHWEST FOOT & ANKLE ASSOCIATES, P.S.
Other - Org Name:EDMONDS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-775-1505
Mailing Address - Street 1:21229 84TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7304
Mailing Address - Country:US
Mailing Address - Phone:425-775-1505
Mailing Address - Fax:425-775-9078
Practice Address - Street 1:21229 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7304
Practice Address - Country:US
Practice Address - Phone:425-775-1505
Practice Address - Fax:425-775-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO0000489213EP1101X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4241730001Medicare NSC
WA8867782Medicare PIN