Provider Demographics
NPI:1245425925
Name:MILL CREEK FOOT & ANKLE CLINIC P.C.
Entity type:Organization
Organization Name:MILL CREEK FOOT & ANKLE CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-482-6663
Mailing Address - Street 1:16708 BOTHELL EVERETT HWY
Mailing Address - Street 2:#204
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-482-6663
Mailing Address - Fax:425-482-6665
Practice Address - Street 1:16708 BOTHELL EVERETT HWY
Practice Address - Street 2:#204
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-482-6663
Practice Address - Fax:425-482-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000593213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB28253Medicare PIN
WAU73094Medicare UPIN
WA4863020001Medicare NSC
WAAB28253Medicare PIN