Provider Demographics
NPI:1144407685
Name:COMMUNITY FOOT AND ANKLE CLINIC, PC
Entity Type:Organization
Organization Name:COMMUNITY FOOT AND ANKLE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-451-5271
Mailing Address - Street 1:9351 GRANT ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4358
Mailing Address - Country:US
Mailing Address - Phone:303-451-5271
Mailing Address - Fax:303-452-4398
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:SUITE 490
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4358
Practice Address - Country:US
Practice Address - Phone:303-451-5271
Practice Address - Fax:303-452-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00307213ES0103X
CO00520213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCD1303Medicare PIN