Provider Demographics
NPI:1861643819
Name:STILWELL FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:STILWELL FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:STILWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-259-5303
Mailing Address - Street 1:575 RIVERGATE
Mailing Address - Street 2:SUITE 95
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-5303
Mailing Address - Fax:970-259-3510
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:SUITE 95
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-5303
Practice Address - Fax:970-259-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO380213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003805Medicaid
COC50063Medicare PIN
CO01003805Medicaid
CO3863730001Medicare NSC