Provider Demographics
NPI:1003294083
Name:FOOT AND ANKLE INSTITUTE OF COLORADO, PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE OF COLORADO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DIEHL
Authorized Official - Last Name:HINDERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-488-4664
Mailing Address - Street 1:1465 KELLY JOHNSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3945
Mailing Address - Country:US
Mailing Address - Phone:719-488-4664
Mailing Address - Fax:719-488-4667
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3945
Practice Address - Country:US
Practice Address - Phone:719-488-4664
Practice Address - Fax:719-488-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO707213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40585042Medicaid