Provider Demographics
NPI:1720428626
Name:ELITE FOOT & ANKLE CLINIC
Entity type:Organization
Organization Name:ELITE FOOT & ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-481-7597
Mailing Address - Street 1:3879 E 120TH AVE
Mailing Address - Street 2:#337
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1658
Mailing Address - Country:US
Mailing Address - Phone:720-328-2022
Mailing Address - Fax:720-328-1224
Practice Address - Street 1:3655 E 104TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4469
Practice Address - Country:US
Practice Address - Phone:720-328-2022
Practice Address - Fax:720-328-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD-698213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty