Provider Demographics
NPI:1093756702
Name:MOUNTAIN VIEW FOOT AND ANKLE CLINIC PC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FOOT AND ANKLE CLINIC PC
Other - Org Name:MVFAC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TOWNSEND
Authorized Official - Last Name:HARTLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-772-3232
Mailing Address - Street 1:1305 SUMNER ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3271
Mailing Address - Country:US
Mailing Address - Phone:303-772-3232
Mailing Address - Fax:303-772-2360
Practice Address - Street 1:1305 SUMNER ST
Practice Address - Street 2:STE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3271
Practice Address - Country:US
Practice Address - Phone:303-772-3232
Practice Address - Fax:303-772-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO326213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC507698Medicare PIN
CO0634340001Medicare NSC