Healthcare Provider Details

I. General information

NPI: 1265593594
Provider Name (Legal Business Name): ACADEMY HEIGHTS FOOT CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD STE 310
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

1155 KELLY JOHNSON BLVD STE 310
COLORADO SPRINGS CO
80920-3959
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-9800
  • Fax: 719-574-9749
Mailing address:
  • Phone: 719-574-9800
  • Fax: 719-574-9749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number366
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number656
License Number StateCO

VIII. Authorized Official

Name: DR. LEE T FLEMING
Title or Position: OWNER
Credential: DPM
Phone: 719-574-9800