Provider Demographics
NPI:1295030971
Name:FAMILY FOOT CLINIC INC
Entity type:Organization
Organization Name:FAMILY FOOT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-845-0564
Mailing Address - Street 1:120 14TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3718
Mailing Address - Country:US
Mailing Address - Phone:253-845-0564
Mailing Address - Fax:253-770-8482
Practice Address - Street 1:120 14TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3718
Practice Address - Country:US
Practice Address - Phone:253-845-0564
Practice Address - Fax:253-770-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 60188334261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427077114OtherINDIVIDUAL NPI NUMBER