Provider Demographics
NPI:1174245088
Name:ELITE FOOT & ANKLE CLINIC
Entity type:Organization
Organization Name:ELITE FOOT & ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-328-2022
Mailing Address - Street 1:3879 E 120TH AVE # 337
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1658
Mailing Address - Country:US
Mailing Address - Phone:720-328-2022
Mailing Address - Fax:720-328-1224
Practice Address - Street 1:3655 E 104TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-6136
Practice Address - Country:US
Practice Address - Phone:720-328-2022
Practice Address - Fax:720-328-1224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE FOOT & ANKLE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000151359Medicaid