Healthcare Provider Details

I. General information

NPI: 1962007211
Provider Name (Legal Business Name): ACADEMY HEIGHTS FOOT CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N UNION BLVD
COLORADO SPRINGS CO
80909-2884
US

IV. Provider business mailing address

PO BOX 9040
WOODLAND PARK CO
80866-9040
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-7878
  • Fax: 719-574-9749
Mailing address:
  • Phone: 719-574-9800
  • Fax: 719-960-2449

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: LEE T FLEMING
Title or Position: PRESIDENT
Credential: DPM
Phone: 719-574-9800