Provider Demographics
NPI:1942215769
Name:A NEW STEP FOOT & ANKLE CLINICS
Entity Type:Organization
Organization Name:A NEW STEP FOOT & ANKLE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-533-0200
Mailing Address - Street 1:1955 DOMINION WAY
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1480
Mailing Address - Country:US
Mailing Address - Phone:719-533-0200
Mailing Address - Fax:719-533-2445
Practice Address - Street 1:1955 DOMINION WAY
Practice Address - Street 2:SUITE # 130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1480
Practice Address - Country:US
Practice Address - Phone:719-533-0200
Practice Address - Fax:719-533-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804239Medicare PIN