Provider Demographics
NPI:1366650640
Name:HIGH PLAINS FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:HIGH PLAINS FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-542-0221
Mailing Address - Street 1:411 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2136
Mailing Address - Country:US
Mailing Address - Phone:970-542-0221
Mailing Address - Fax:970-542-9585
Practice Address - Street 1:411 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2136
Practice Address - Country:US
Practice Address - Phone:970-542-0221
Practice Address - Fax:970-542-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO506261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01005065Medicaid
COC484588Medicare ID - Type Unspecified
CO01005065Medicaid