Provider Demographics
NPI:1508048091
Name:FOOT AND ANKLE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:FOOT AND ANKLE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-754-3338
Mailing Address - Street 1:1220 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3018
Mailing Address - Country:US
Mailing Address - Phone:360-736-4151
Mailing Address - Fax:
Practice Address - Street 1:1220 W 1ST ST
Practice Address - Street 2:STE B
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3018
Practice Address - Country:US
Practice Address - Phone:360-736-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000517261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB33649Medicare PIN