Provider Demographics
NPI:1578799698
Name:THE FOOT AND ANKLE CENTER OF COLORADO PC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE CENTER OF COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-475-1552
Mailing Address - Street 1:9695 SOUTH YOSEMITE STREET
Mailing Address - Street 2:SUITE 373
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-662-0545
Mailing Address - Fax:720-398-3395
Practice Address - Street 1:9695 SOUTH YOSEMITE STREET
Practice Address - Street 2:SUITE 373
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-662-0545
Practice Address - Fax:720-398-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
500078Medicare UPIN