Provider Demographics
NPI:1265593594
Name:ACADEMY HEIGHTS FOOT CLINIC PC
Entity type:Organization
Organization Name:ACADEMY HEIGHTS FOOT CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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 1:1155 KELLY JOHNSON BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3959
Mailing Address - Country:US
Mailing Address - Phone:719-574-9800
Mailing Address - Fax:719-574-9749
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-574-9800
Practice Address - Fax:719-574-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO366213ES0103X
CO656213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89502086Medicaid
CO0470500001Medicare NSC
COC806684Medicare PIN