MEDICARE: GROTH FOOT & ANKLE CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist

General Provider Information

NPI Number	:	1356694228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROTH FOOT & ANKLE CLINIC PC

Provider Business Mailing Address
First Line	:	3920 N UNION BLVD STE 320
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80907-4916
Country	:	US
Telephone Number	:	719-574-2000
Fax Number	:	719-574-6477

Provider Business Practice Location Address
First Line	:	3920 N UNION BLVD STE 320
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80907-4916
Country	:	US
Telephone Number	:	719-574-2000
Fax Number	:	719-574-6477

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYAN ALAN GROTH
Credential	:	DPM
Telephone Number	:	719-574-2000

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/17/2012

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