Provider Demographics
NPI:1013031400
Name:FOOTHILLS MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FOOTHILLS MEDICAL ASSOCIATES PLLC
Other - Org Name:20 MILE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:720-974-7210
Mailing Address - Street 1:11355 S PARKER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7403
Mailing Address - Country:US
Mailing Address - Phone:303-974-7210
Mailing Address - Fax:
Practice Address - Street 1:11355 S PARKER RD STE 103
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7403
Practice Address - Country:US
Practice Address - Phone:303-974-7210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty