Provider Demographics
NPI:1790999035
Name:PUEBLO ANKLE AND FOOT CARE, PLLC
Entity Type:Organization
Organization Name:PUEBLO ANKLE AND FOOT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-544-7170
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:#300
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2657
Mailing Address - Country:US
Mailing Address - Phone:719-543-2476
Mailing Address - Fax:719-543-2479
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:#300
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2657
Practice Address - Country:US
Practice Address - Phone:719-543-2476
Practice Address - Fax:719-543-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO665213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12630861Medicaid
COPUPU665OtherBC
CODG0622OtherRAILROAD MEDICARE
COPUPU665OtherBC
CO6054940001Medicare NSC
CO808770Medicare UPIN