Healthcare Provider Details

I. General information

NPI: 1669548988
Provider Name (Legal Business Name): FOOT & ANKLE CENTER OF SOUTHERN COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E PIKES PEAK AVE STE 220
COLORADO SPRINGS CO
80903-3673
US

IV. Provider business mailing address

455 E PIKES PEAK AVE SUITE 220
COLORADO SPRINGS CO
80903-3648
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-8080
  • Fax: 719-475-0913
Mailing address:
  • Phone: 719-475-8080
  • Fax: 719-475-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC J GESSNER
Title or Position: MANAGING OWNER
Credential: DPM
Phone: 719-475-8080