Provider Demographics
NPI:1295748895
Name:COLORADO FOOT AND ANKLE CLINIC PC
Entity type:Organization
Organization Name:COLORADO FOOT AND ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-777-8767
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7007
Mailing Address - Country:US
Mailing Address - Phone:303-777-8767
Mailing Address - Fax:303-996-1336
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7007
Practice Address - Country:US
Practice Address - Phone:303-777-8767
Practice Address - Fax:303-996-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO605213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55357253Medicaid
CO55357253Medicaid
CO459768Medicare PIN