Provider Demographics
NPI:1457510984
Name:LOVELAND FOOT & ANKLE CLINIC PC
Entity Type:Organization
Organization Name:LOVELAND FOOT & ANKLE CLINIC PC
Other - Org Name:ADVANCED FOOT & ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-278-1440
Mailing Address - Street 1:1440 BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4214
Mailing Address - Country:US
Mailing Address - Phone:970-278-1440
Mailing Address - Fax:970-203-0329
Practice Address - Street 1:1440 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4214
Practice Address - Country:US
Practice Address - Phone:970-278-1440
Practice Address - Fax:970-203-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO379213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32707339Medicaid
CO32707339Medicaid