MEDICARE: ANDERSON PODIATRY CENTER 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	213ES0103X	Foot & Ankle Surgery Podiatrist	662	CO
2	213EP1101X	Primary Podiatric Medicine Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4800195741	OTHER	CO	RR MEDICARE
3	CJ4464	OTHER	WY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457571127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON PODIATRY CENTER PC

Provider Business Mailing Address
First Line	:	1355 RIVERSIDE AVE
Second Line	:	SUITE C
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4368
Country	:	US
Telephone Number	:	970-484-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 RIVERSIDE AVE
Second Line	:	SUITE C
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4368
Country	:	US
Telephone Number	:	970-484-4620
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES CHARLES ANDERSON
Credential	:	DPM
Telephone Number	:	970-484-4620

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	10/27/2014

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Directions to “ANDERSON PODIATRY CENTER PC ” Practice Location

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