Provider Demographics
NPI:1609637149
Name:BLUE SKY FOOT & ANKLE
Entity Type:Organization
Organization Name:BLUE SKY FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-514-2559
Mailing Address - Street 1:300 CENTER DRIVE
Mailing Address - Street 2:SUITE G, #395
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 TABLE MESA DR STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5850
Practice Address - Country:US
Practice Address - Phone:720-798-3208
Practice Address - Fax:720-798-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty