Provider Demographics
NPI:1821613878
Name:ADVANCED FOOT CARE, PC
Entity Type:Organization
Organization Name:ADVANCED FOOT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:307-514-9901
Mailing Address - Street 1:4112 LARAMIE ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1969
Mailing Address - Country:US
Mailing Address - Phone:307-514-9901
Mailing Address - Fax:
Practice Address - Street 1:313 W DRAKE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2846
Practice Address - Country:US
Practice Address - Phone:970-225-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED FOOT CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-15
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty