Provider Demographics
NPI:1780866459
Name:INTERMOUNTAIN FOOT & ANKLE ASSOC P.C
Entity Type:Organization
Organization Name:INTERMOUNTAIN FOOT & ANKLE ASSOC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ELIZEBETH
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-594-9920
Mailing Address - Street 1:9348 GRAND CORDERA
Mailing Address - Street 2:PKWY 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-4062
Mailing Address - Country:US
Mailing Address - Phone:719-594-9920
Mailing Address - Fax:719-598-6212
Practice Address - Street 1:9348 GRAND CORDERA PKWY STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7002
Practice Address - Country:US
Practice Address - Phone:719-594-9920
Practice Address - Fax:719-598-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO517213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCD1850OtherRAILROAD MEDICARE
CO01005180Medicaid
CO04532339Medicaid
CO04532339Medicaid
CO01005180Medicaid
CO0344420002Medicare NSC