Healthcare Provider Details

I. General information

NPI: 1417202318
Provider Name (Legal Business Name): NORTH COLORADO SPRINGS FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N UNION BLVD SUITE 104
COLORADO SPRINGS CO
80920-4084
US

IV. Provider business mailing address

7730 N UNION BLVD SUITE 104
COLORADO SPRINGS CO
80920-4084
US

V. Phone/Fax

Practice location:
  • Phone: 719-548-1313
  • Fax: 719-592-0265
Mailing address:
  • Phone: 719-548-1313
  • Fax: 719-592-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number394
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID MANUEL GARCIA
Title or Position: OWNER
Credential: D.P.M.
Phone: 719-548-1313