Provider Demographics
NPI:1326227893
Name:A NEW STEP FOOT ANKLE CLINIC
Entity Type:Organization
Organization Name:A NEW STEP FOOT ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-533-0200
Mailing Address - Street 1:6455 N UNION BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5842
Mailing Address - Country:US
Mailing Address - Phone:719-533-0200
Mailing Address - Fax:719-533-2445
Practice Address - Street 1:6455 N UNION BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5842
Practice Address - Country:US
Practice Address - Phone:719-533-0200
Practice Address - Fax:719-533-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5604420001Medicare NSC