Basic Information
| Provider Information | |||||||||
| NPI: | 1386984573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE FOOT & ANKLE CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4950 S YOSEMITE ST | ||||||||
| Address2: | F2-242 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801111349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Practice Location | |||||||||
| Address1: | 9898 ROSEMONT AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801244106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 02/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2392781155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | POD0000702 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.