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General NPI Number Information
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NPI Number | 1942349501
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Entity Type | Organization
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Legal Business Name | BLUE MESA FOOT & ANKLE CENTERS INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 2798 WOODGATE RD UNIT D
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City | MONTROSE
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State | CO
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Zip | 81401-5686
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Country | US
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Telephone | 970-252-3470
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Fax | 970-252-3471
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Provider Business Mailing Address
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Address Line | 2798 WOODGATE RD UNIT D
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City | MONTROSE
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State | CO
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Zip | 81401-5686
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Country | US
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Telephone | 970-252-3470
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Fax | 970-252-3471
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Authorized Official
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Title or Position | PRESIDENT
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Name | CALVIN D BAIZE
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Credential | DPM
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Telephone | 970-252-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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