Provider Demographics
NPI:1841838943
Name:CC FOOT CLINIC PC
Entity type:Organization
Organization Name:CC FOOT CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-355-1695
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:850 E HARVARD AVE STE 385
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5076
Practice Address - Country:US
Practice Address - Phone:303-762-1200
Practice Address - Fax:303-762-0508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CC FOOT CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric