Provider Demographics
NPI:1871771311
Name:PERFORMANCE FOOT AND ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:PERFORMANCE FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LOWINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-782-7300
Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3909
Mailing Address - Country:US
Mailing Address - Phone:206-782-7300
Mailing Address - Fax:206-414-7390
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3909
Practice Address - Country:US
Practice Address - Phone:206-782-7300
Practice Address - Fax:206-414-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000783213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5823620001OtherDMERC
WA8439713Medicaid
V05591Medicare UPIN
WA8439713Medicaid
WA6142060001Medicare NSC