Basic Information
| Provider Information | |||||||||
| NPI: | 1154371391 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOT AND ANKLE SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17820 1ST AVE S | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065925000 | ||||||||
| FaxNumber: | 2068249510 | ||||||||
| Practice Location | |||||||||
| Address1: | 17820 1ST AVE S | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062483668 | ||||||||
| FaxNumber: | 2062442499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | GREENAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MBR/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2062483668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5823620001 | 01 | WA | DME SUPPLIER NUMBER | OTHER | 7132327 | 05 | WA | MEDICAID | DE6917 | 01 | WA | RR MEDICARE | OTHER |