=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609637149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE SKY FOOT & ANKLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2024
-----------------------------------------------------
Last Update Date | 01/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 TABLE MESA DR STE 102
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80305-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-798-3208
-----------------------------------------------------
Fax | 720-798-5924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CENTER DRIVE SUITE G, #395
-----------------------------------------------------
City | SUPERIOR
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST, OWNER
-----------------------------------------------------
Name | MEGHAN KATHLEEN MORGAN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 253-514-2559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------