Healthcare Provider Details

I. General information

NPI: 1780866459
Provider Name (Legal Business Name): INTERMOUNTAIN FOOT & ANKLE ASSOC P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9348 GRAND CORDERA PKWY STE 210
COLORADO SPRINGS CO
80924-7002
US

IV. Provider business mailing address

9348 GRAND CORDERA PKWY 210
COLORADO SPRINGS CO
80924-4062
US

V. Phone/Fax

Practice location:
  • Phone: 719-594-9920
  • Fax: 719-598-6212
Mailing address:
  • Phone: 719-594-9920
  • Fax: 719-598-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number517
License Number StateCO

VIII. Authorized Official

Name: DR. KERRY ELIZEBETH BERG
Title or Position: OWNER/PHYSICIAN
Credential: D.P.M.
Phone: 719-594-9920