Provider Demographics
NPI:1821228495
Name:LONGMONT FOOT AND ANKLE CLINIC, P.C.
Entity Type:Organization
Organization Name:LONGMONT FOOT AND ANKLE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-776-9122
Mailing Address - Street 1:1330 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3217
Mailing Address - Country:US
Mailing Address - Phone:303-776-9122
Mailing Address - Fax:303-774-9572
Practice Address - Street 1:1330 VIVIAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3217
Practice Address - Country:US
Practice Address - Phone:303-776-9122
Practice Address - Fax:303-774-9572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO609213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90233573Medicaid
CO1164647715OtherINDIVIDUAL NPI
CO1164647715OtherINDIVIDUAL NPI
CO6266510001Medicare NSC
CO90233573Medicaid