Healthcare Provider Details

I. General information

NPI: 1386984573
Provider Name (Legal Business Name): ELITE FOOT & ANKLE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9898 ROSEMONT AVE SUITE 103
LONE TREE CO
80124-4106
US

IV. Provider business mailing address

4950 S YOSEMITE ST F2-242
GREENWOOD VILLAGE CO
80111-1349
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-1155
  • Fax: 239-278-1159
Mailing address:
  • Phone: 239-278-1155
  • Fax: 239-278-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD0000702
License Number StateCO

VIII. Authorized Official

Name: CHAD SIMMONS
Title or Position: OWNER
Credential: DPM
Phone: 239-278-1155