Provider Demographics
NPI:1427719558
Name:FOUR CORNERS FOOT AND ANKLE PC
Entity type:Organization
Organization Name:FOUR CORNERS FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYSE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-5303
Mailing Address - Street 1:1266 ESCALANTE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8934
Mailing Address - Country:US
Mailing Address - Phone:970-259-5303
Mailing Address - Fax:970-259-3510
Practice Address - Street 1:1266 ESCALANTE DR STE 201
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8934
Practice Address - Country:US
Practice Address - Phone:970-259-5303
Practice Address - Fax:970-259-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies