Provider Demographics
NPI:1508589730
Name:FOOT & ANKLE CENTER OF SOUTHERN COLORADO PC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF SOUTHERN COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-475-8080
Mailing Address - Street 1:455 E PIKES PEAK AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3673
Mailing Address - Country:US
Mailing Address - Phone:719-475-8080
Mailing Address - Fax:
Practice Address - Street 1:455 E PIKES PEAK AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3673
Practice Address - Country:US
Practice Address - Phone:719-475-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site