Provider Demographics
NPI:1174794622
Name:HIGHLANDS FOOT AND ANKLE CLINIC
Entity type:Organization
Organization Name:HIGHLANDS FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-346-3399
Mailing Address - Street 1:PO BOX 632133
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163-2133
Mailing Address - Country:US
Mailing Address - Phone:303-346-3399
Mailing Address - Fax:
Practice Address - Street 1:9331 S COLORADO BLVD
Practice Address - Street 2:STE. #150
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7467
Practice Address - Country:US
Practice Address - Phone:303-346-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO584213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800908Medicare PIN
COU92924Medicare UPIN