Provider Demographics
NPI:1982703583
Name:BELLINGHAM FOOT CLINIC INC PS
Entity Type:Organization
Organization Name:BELLINGHAM FOOT CLINIC INC PS
Other - Org Name:BELLINGHAM FOOT & ANKLE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-305-1661
Mailing Address - Street 1:520 BIRCHWOOD AVE. STE A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1755
Mailing Address - Country:US
Mailing Address - Phone:360-734-3668
Mailing Address - Fax:360-676-8941
Practice Address - Street 1:520 BIRCHWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1700
Practice Address - Country:US
Practice Address - Phone:360-734-3668
Practice Address - Fax:360-676-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60697482213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T03157Medicare UPIN
WAG001400196Medicare PIN