1922605252 NPI number — PUEBLO ANKLE AND FOOT CARE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922605252 NPI number — PUEBLO ANKLE AND FOOT CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUEBLO ANKLE AND FOOT CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922605252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1619 N GREENWOOD ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81003-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-543-2476
Provider Business Mailing Address Fax Number:
719-543-2479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 S PURCELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO WEST
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81007-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-543-2476
Provider Business Practice Location Address Fax Number:
719-543-2479
Provider Enumeration Date:
10/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HELVEY
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
BILLING & CREDENTIALING LEAD
Authorized Official Telephone Number:
719-544-7170

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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