Provider Demographics
NPI:1255574182
Name:BOULDER COUNTY FOOT & ANKLE, PC
Entity type:Organization
Organization Name:BOULDER COUNTY FOOT & ANKLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:JACHIMIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-442-2910
Mailing Address - Street 1:2575 PEARL ST
Mailing Address - Street 2:#240
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3851
Mailing Address - Country:US
Mailing Address - Phone:303-449-2910
Mailing Address - Fax:303-442-2931
Practice Address - Street 1:2575 PEARL ST
Practice Address - Street 2:#240
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3851
Practice Address - Country:US
Practice Address - Phone:303-449-2910
Practice Address - Fax:303-449-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57284377Medicaid
CO6726940001Medicare NSC
CO57284377Medicaid