Provider Demographics
NPI:1740595826
Name:STILL FOOT & ANKLE CARE CENTER, PC
Entity type:Organization
Organization Name:STILL FOOT & ANKLE CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-763-4900
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:#250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-763-4900
Mailing Address - Fax:303-763-7155
Practice Address - Street 1:1707 COLE BLVD
Practice Address - Street 2:#150
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3220
Practice Address - Country:US
Practice Address - Phone:303-233-8295
Practice Address - Fax:303-233-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO547213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101993OtherGROUP PTAN
CO36132071Medicaid
COCOA101993OtherGROUP PTAN