Provider Demographics
NPI:1811372113
Name:GUNNISON PODIATRY LLC
Entity Type:Organization
Organization Name:GUNNISON PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:OSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-258-3825
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2243
Mailing Address - Country:US
Mailing Address - Phone:970-497-9932
Mailing Address - Fax:970-465-7313
Practice Address - Street 1:711 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2243
Practice Address - Country:US
Practice Address - Phone:970-497-9932
Practice Address - Fax:970-465-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP1100X261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80563Medicare UPIN
OH0535215Medicare PIN
CO449336ZRSXMedicare PIN