Provider Demographics
NPI:1962007211
Name:ACADEMY HEIGHTS FOOT CLINIC PC
Entity Type:Organization
Organization Name:ACADEMY HEIGHTS FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-574-9800
Mailing Address - Street 1:PO BOX 9040
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-9040
Mailing Address - Country:US
Mailing Address - Phone:719-574-9800
Mailing Address - Fax:719-960-2449
Practice Address - Street 1:1512 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2884
Practice Address - Country:US
Practice Address - Phone:719-632-7878
Practice Address - Fax:719-574-9749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADEMY HEIGHTS FOOT CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty