1629254339 NPI number — ALPINE FOOT & ANKLE CLINIC, PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629254339 NPI number — ALPINE FOOT & ANKLE CLINIC, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPINE FOOT & ANKLE CLINIC, PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629254339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17432 SMOKEY POINT BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-6363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-653-2326
Provider Business Mailing Address Fax Number:
360-658-8944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17432 SMOKEY POINT BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-6363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-653-2326
Provider Business Practice Location Address Fax Number:
360-658-8944
Provider Enumeration Date:
01/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAWLEY
Authorized Official First Name:
FRED
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
360-653-2326

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO676 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: PO676 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: PO676 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7111271 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".