Provider Demographics
NPI:1669699781
Name:FOOT & ANKLE INC
Entity type:Organization
Organization Name:FOOT & ANKLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RION
Authorized Official - Middle Name:AGAR
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-368-7000
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-368-7000
Mailing Address - Fax:206-361-9273
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:STE 130
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-368-7000
Practice Address - Fax:206-361-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000286213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADB8710Medicare PIN
WA5180330001Medicare NSC
WAG8802253Medicare PIN
WAG8906535Medicare PIN