Provider Demographics
NPI:1588842124
Name:COMPLETE FOOT CARE, P.C.
Entity Type:Organization
Organization Name:COMPLETE FOOT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-544-5958
Mailing Address - Street 1:2037 JERRY MURPHY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1256
Mailing Address - Country:US
Mailing Address - Phone:719-544-5958
Mailing Address - Fax:719-544-5991
Practice Address - Street 1:2037 JERRY MURPHY RD STE 100
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1256
Practice Address - Country:US
Practice Address - Phone:719-544-5958
Practice Address - Fax:719-544-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO595213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5683630001Medicare NSC
COU77272Medicare UPIN
COC550418Medicare PIN