Provider Demographics
NPI:1386984573
Name:ELITE FOOT & ANKLE CENTER PC
Entity type:Organization
Organization Name:ELITE FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-278-1155
Mailing Address - Street 1:4950 S YOSEMITE ST
Mailing Address - Street 2:F2-242
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1349
Mailing Address - Country:US
Mailing Address - Phone:239-278-1155
Mailing Address - Fax:239-278-1159
Practice Address - Street 1:9898 ROSEMONT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4106
Practice Address - Country:US
Practice Address - Phone:239-278-1155
Practice Address - Fax:239-278-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD0000702213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBV989ZMedicare PIN