MEDICARE: FOOT AND ANKLE INSTITUTE OF COLORADO, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	707	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003294083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE INSTITUTE OF COLORADO, PC

Provider Business Mailing Address
First Line	:	1465 KELLY JOHNSON BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3945
Country	:	US
Telephone Number	:	719-488-4664
Fax Number	:	719-488-4667

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3945
Country	:	US
Telephone Number	:	719-488-4664
Fax Number	:	719-488-4667

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. MATTHEW DIEHL HINDERLAND
Credential	:	D.P.M.
Telephone Number	:	719-488-4664

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	02/28/2020

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Directions to “FOOT AND ANKLE INSTITUTE OF COLORADO, PC ” Practice Location

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