Healthcare Provider Details

I. General information

NPI: 1841469012
Provider Name (Legal Business Name): SALLY A SERVOLD DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 23RD ST SUITE 205
GLENWOOD SPRINGS CO
81601-4363
US

IV. Provider business mailing address

401 23RD ST SUITE 205
GLENWOOD SPRINGS CO
81601-4363
US

V. Phone/Fax

Practice location:
  • Phone: 970-928-9785
  • Fax: 970-928-0423
Mailing address:
  • Phone: 970-928-9785
  • Fax: 970-928-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0459
License Number StateCO

VIII. Authorized Official

Name: DR. SALLY A SERVOLD
Title or Position: PRESIDENT
Credential: DPM
Phone: 970-928-9785