Provider Demographics
NPI:1982745600
Name:PORT TOWNSEND FOOT AND ANKLE CLINIC PS
Entity Type:Organization
Organization Name:PORT TOWNSEND FOOT AND ANKLE CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-385-6486
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-352-0637
Practice Address - Street 1:204 GAINES ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6902
Practice Address - Country:US
Practice Address - Phone:360-385-6486
Practice Address - Fax:360-385-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000797213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0216774OtherLABOR & INDUSTRIES
WAP00371973OtherMEDICARE RR
WA1123595Medicaid
WA1123595Medicaid
WA5846080001Medicare NSC