Healthcare Provider Details

I. General information

NPI: 1922605252
Provider Name (Legal Business Name): PUEBLO ANKLE AND FOOT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 05/04/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S PURCELL BLVD
PUEBLO WEST CO
81007-5045
US

IV. Provider business mailing address

1619 N GREENWOOD ST STE 300
PUEBLO CO
81003-2657
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-2476
  • Fax: 719-543-2479
Mailing address:
  • Phone: 719-543-2476
  • Fax: 719-543-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA MARIE HELVEY
Title or Position: BILLING & CREDENTIALING LEAD
Credential:
Phone: 719-544-7170