Provider Demographics
NPI:1720207863
Name:GRAND VALLEY FOOT & ANKLE CENTER PC
Entity Type:Organization
Organization Name:GRAND VALLEY FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-245-3338
Mailing Address - Street 1:2530 N 8TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8858
Mailing Address - Country:US
Mailing Address - Phone:970-245-3338
Mailing Address - Fax:970-245-9499
Practice Address - Street 1:2530 N 8TH ST STE 206
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8858
Practice Address - Country:US
Practice Address - Phone:970-245-3338
Practice Address - Fax:970-245-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015509Medicaid
CO1152560002Medicare NSC
COA2203Medicare PIN