Provider Demographics
NPI:1356520548
Name:CENTRAL WASHINGTON PODIATRY SERVICE PLLC
Entity type:Organization
Organization Name:CENTRAL WASHINGTON PODIATRY SERVICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ORMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-248-4900
Mailing Address - Street 1:307 S 12TH AVE
Mailing Address - Street 2:SUITE #9
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3100
Mailing Address - Country:US
Mailing Address - Phone:509-248-4900
Mailing Address - Fax:509-248-0609
Practice Address - Street 1:307 S 12TH AVE
Practice Address - Street 2:SUITE #9
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3100
Practice Address - Country:US
Practice Address - Phone:509-248-4900
Practice Address - Fax:509-248-0609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL WASHINGTON PODIATRY SERVICE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB10697Medicare PIN