Provider Demographics
NPI:1184397036
Name:EVERETT FOOT CLINIC PLLC
Entity type:Organization
Organization Name:EVERETT FOOT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF ORGANIZATION
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-259-3757
Mailing Address - Street 1:3401 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4281
Mailing Address - Country:US
Mailing Address - Phone:425-259-3757
Mailing Address - Fax:425-259-6565
Practice Address - Street 1:3401 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4281
Practice Address - Country:US
Practice Address - Phone:425-259-3757
Practice Address - Fax:425-259-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty