Provider Demographics
NPI:1417202318
Name:NORTH COLORADO SPRINGS FOOT CLINIC
Entity Type:Organization
Organization Name:NORTH COLORADO SPRINGS FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-548-1313
Mailing Address - Street 1:7730 N UNION BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4084
Mailing Address - Country:US
Mailing Address - Phone:719-548-1313
Mailing Address - Fax:719-592-0265
Practice Address - Street 1:7730 N UNION BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4084
Practice Address - Country:US
Practice Address - Phone:719-548-1313
Practice Address - Fax:719-592-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO394213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01394006Medicaid