Provider Demographics
NPI:1811177975
Name:FAMILY FOOT HEALTH CENTER INC.
Entity type:Organization
Organization Name:FAMILY FOOT HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-841-4262
Mailing Address - Street 1:11212 SUNRISE BLVD E
Mailing Address - Street 2:# 203
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8847
Mailing Address - Country:US
Mailing Address - Phone:253-841-4262
Mailing Address - Fax:253-841-7112
Practice Address - Street 1:11212 SUNRISE BLVD E
Practice Address - Street 2:# 203
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8847
Practice Address - Country:US
Practice Address - Phone:253-841-4262
Practice Address - Fax:253-841-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 00000441213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA59623OtherL&I GRP
WAU26011Medicare UPIN
WAG8851583Medicare PIN
WA59623OtherL&I GRP
WAG8851584Medicare PIN
WAG001002229Medicare PIN