Provider Demographics
NPI:1215085402
Name:PETERSON FOOT CARE, INC.
Entity type:Organization
Organization Name:PETERSON FOOT CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:303-333-1553
Mailing Address - Street 1:5910 S UNIVERSITY BLVD
Mailing Address - Street 2:STE B2
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2879
Mailing Address - Country:US
Mailing Address - Phone:303-333-1553
Mailing Address - Fax:303-794-1268
Practice Address - Street 1:5910 S UNIVERSITY BLVD
Practice Address - Street 2:STE B2
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2879
Practice Address - Country:US
Practice Address - Phone:303-333-1553
Practice Address - Fax:303-794-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5192380001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT