Healthcare Provider Details

I. General information

NPI: 1013116938
Provider Name (Legal Business Name): FOOT SURGERY CENTER OF NORTHERN COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RIVERSIDE AVE SUITE B
FORT COLLINS CO
80524
US

IV. Provider business mailing address

1355 RIVERSIDE AVE SUITE B
FORT COLLINS CO
80524
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4620
  • Fax:
Mailing address:
  • Phone: 970-484-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number662
License Number StateCO

VIII. Authorized Official

Name: DR. JAMES CHARLES ANDERSON
Title or Position: OWNER
Credential: DPM
Phone: 970-484-4620