Provider Demographics
NPI:1942349501
Name:BLUE MESA FOOT & ANKLE CENTERS INC
Entity Type:Organization
Organization Name:BLUE MESA FOOT & ANKLE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAIZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-252-3470
Mailing Address - Street 1:2798 WOODGATE RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5686
Mailing Address - Country:US
Mailing Address - Phone:970-252-3470
Mailing Address - Fax:970-252-3471
Practice Address - Street 1:2798 WOODGATE RD UNIT D
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5686
Practice Address - Country:US
Practice Address - Phone:970-252-3470
Practice Address - Fax:970-252-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB51582OtherBLUE CROSS BLUE SHIELD
CO21175845Medicaid
CODA3780OtherRAIL ROAD MEDICARE
COB51582OtherBLUE CROSS BLUE SHIELD
COC493998Medicare PIN