Provider Demographics
NPI:1003449521
Name:FOOT AND ANKLE CENTER OF THE ROCKIES LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF THE ROCKIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-351-0900
Mailing Address - Street 1:1305 SUMNER ST UNIT 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3270
Mailing Address - Country:US
Mailing Address - Phone:303-772-3232
Mailing Address - Fax:
Practice Address - Street 1:1305 SUMNER ST UNIT 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3270
Practice Address - Country:US
Practice Address - Phone:303-772-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT AND ANKLE CENTER OF THE ROCKIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty