Provider Demographics
NPI:1770616567
Name:FOOT & ANKLE CENTER OF NORTHERN COLORADO,PC
Entity type:Organization
Organization Name:FOOT & ANKLE CENTER OF NORTHERN COLORADO,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-351-0900
Mailing Address - Street 1:1931 65TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7946
Mailing Address - Country:US
Mailing Address - Phone:970-351-0900
Mailing Address - Fax:970-351-0940
Practice Address - Street 1:1931 65TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7946
Practice Address - Country:US
Practice Address - Phone:970-351-0900
Practice Address - Fax:970-351-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008942Medicaid
COCA0403Medicare PIN
COCI8364Medicare PIN
CO04008942Medicaid