Provider Demographics
NPI:1255485454
Name:FOOTHILLS SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:FOOTHILLS SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-940-8200
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-940-8200
Mailing Address - Fax:303-940-8600
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6021
Practice Address - Country:US
Practice Address - Phone:303-940-8200
Practice Address - Fax:303-940-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010419Medicaid
CO04010419Medicaid