MEDICARE: ACADEMY HEIGHTS FOOT CLINIC 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

General Provider Information

NPI Number	:	1962007211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY HEIGHTS FOOT CLINIC PC

Provider Business Mailing Address
First Line	:	PO BOX 9040
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80866-9040
Country	:	US
Telephone Number	:	719-574-9800
Fax Number	:	719-960-2449

Provider Business Practice Location Address
First Line	:	1512 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2884
Country	:	US
Telephone Number	:	719-632-7878
Fax Number	:	719-574-9749

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEE T FLEMING
Credential	:	DPM
Telephone Number	:	719-574-9800

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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