Provider Demographics
NPI:1396560017
Name:FOOT & ANKLE CENTER OF COLORADO SPRINGS
Entity type:Organization
Organization Name:FOOT & ANKLE CENTER OF COLORADO SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-559-3388
Mailing Address - Street 1:1266 ESCALANTE DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8933
Mailing Address - Country:US
Mailing Address - Phone:719-559-3388
Mailing Address - Fax:719-559-3509
Practice Address - Street 1:6160 TUTT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-1500
Practice Address - Country:US
Practice Address - Phone:719-559-3388
Practice Address - Fax:719-559-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty