Provider Demographics
NPI:1922605252
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 STE 300
Mailing Address - Street 2:
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 1:323 S PURCELL BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5045
Practice Address - Country:US
Practice Address - Phone:719-543-2476
Practice Address - Fax:719-543-2479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUEBLO ANKLE AND FOOT CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808770OtherMEDICARE PIN
CO12630861Medicaid
CO808770OtherMEDICARE UPIN
COPUPU665OtherBC
CO6054940001OtherMEDICARE NSC
CODG0622OtherRR