Healthcare Provider Details

I. General information

NPI: 1508589730
Provider Name (Legal Business Name): FOOT & ANKLE CENTER OF SOUTHERN COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
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 STE 220
COLORADO SPRINGS CO
80903-3673
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: BRIANNE A SIMMONS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-475-8080