Provider Demographics
NPI:1003083841
Name:CHEYENNE FOOT & ANKLE INC
Entity Type:Organization
Organization Name:CHEYENNE FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:V
Authorized Official - Last Name:YULL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-576-2080
Mailing Address - Street 1:2620 TENDERFOOT HILL ST
Mailing Address - Street 2:STE 10
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8353
Mailing Address - Country:US
Mailing Address - Phone:719-576-2080
Mailing Address - Fax:719-576-2248
Practice Address - Street 1:1335 PHAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2334
Practice Address - Country:US
Practice Address - Phone:719-275-1037
Practice Address - Fax:719-275-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO642213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4536100003Medicare NSC