Healthcare Provider Details

I. General information

NPI: 1003294083
Provider Name (Legal Business Name): FOOT AND ANKLE INSTITUTE OF COLORADO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD STE 100
COLORADO SPRINGS CO
80920-3945
US

IV. Provider business mailing address

1465 KELLY JOHNSON BLVD STE 100
COLORADO SPRINGS CO
80920-3945
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-4664
  • Fax: 719-488-4667
Mailing address:
  • Phone: 719-488-4664
  • Fax: 719-488-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number707
License Number StateCO

VIII. Authorized Official

Name: DR. MATTHEW DIEHL HINDERLAND
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 719-488-4664