Provider Demographics
NPI:1609129626
Name:NICHOLAS L HUGENTOBLER PC
Entity Type:Organization
Organization Name:NICHOLAS L HUGENTOBLER PC
Other - Org Name:ANIMAS FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUGENTOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-259-3154
Mailing Address - Street 1:575 RIVERGATE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-3154
Mailing Address - Fax:970-828-1666
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-3154
Practice Address - Fax:970-828-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD0000716213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty