Provider Demographics
NPI:1205903515
Name:ANKLE & FOOT CLINIC OF RENTO
Entity type:Organization
Organization Name:ANKLE & FOOT CLINIC OF RENTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUWADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-251-9174
Mailing Address - Street 1:275 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4930
Mailing Address - Country:US
Mailing Address - Phone:425-251-9174
Mailing Address - Fax:425-251-0758
Practice Address - Street 1:275 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4930
Practice Address - Country:US
Practice Address - Phone:425-251-9174
Practice Address - Fax:425-251-0758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE AND FOOT CLINIC OF RENTON PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA121478OtherLABOR & INDUSTRIES
WA7089626Medicaid
VA8877OtherREGENCE BLUE SHIELD
WAG8854446Medicare PIN