Provider Demographics
NPI:1699337741
Name:SOUTHWEST FOOT AND ANKLE PC
Entity type:Organization
Organization Name:SOUTHWEST FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGENTOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-903-9853
Mailing Address - Street 1:270 E 8TH AVE STE N-102
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5708
Mailing Address - Country:US
Mailing Address - Phone:970-903-9853
Mailing Address - Fax:970-616-6745
Practice Address - Street 1:270 E 8TH AVE STE N-102
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5708
Practice Address - Country:US
Practice Address - Phone:970-903-9853
Practice Address - Fax:970-616-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty