Provider Demographics
NPI:1912255654
Name:FOOT & ANKLE CENTER OF NORTHERN COLORADO, P.C.
Entity type:Organization
Organization Name:FOOT & ANKLE CENTER OF NORTHERN COLORADO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-351-0900
Mailing Address - Street 1:1305 SUMNER STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3270
Mailing Address - Country:US
Mailing Address - Phone:303-772-3232
Mailing Address - Fax:303-772-2360
Practice Address - Street 1:1305 SUMNER STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3270
Practice Address - Country:US
Practice Address - Phone:303-772-3232
Practice Address - Fax:303-772-2360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE CENTER OF NORTHERN COLORADO, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0483700001OtherDME
CO04008942Medicaid
CO0483700001OtherDME
COCA0403Medicare PIN