Provider Demographics
NPI:1558541078
Name:WHEAT RIDGE FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:WHEAT RIDGE FOOT & ANKLE CENTER, PC
Other - Org Name:ROCKY MOUNTAIN FOOT & ANKLE CENTER, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:033-423-2520
Mailing Address - Street 1:7615 W 38TH AVE
Mailing Address - Street 2:SUITE B101
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6172
Mailing Address - Country:US
Mailing Address - Phone:303-423-2520
Mailing Address - Fax:303-423-2536
Practice Address - Street 1:7615 W 38TH AVE UNIT B101
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6138
Practice Address - Country:US
Practice Address - Phone:303-423-2520
Practice Address - Fax:303-423-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA0303Medicare PIN
6460590001Medicare NSC