| Jandyco, LLC | |
|
509 Colorado Ave Ste C Pueblo CO 81004-2008 | |
| (719) 696-9828 | |
| (719) 696-9862 |
| Full Name | Jandyco, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 509 Colorado Ave Ste C, Pueblo, Colorado |
| Authorized Official Name and Position | Jamie M Pollock (OWNER/ PHYSICIAN) |
| Authorized Official Contact | 7192142005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jandyco, LLC 509 Colorado Ave Ste C Pueblo CO 81004-2008 Ph: (719) 214-2005 | Jandyco, LLC 509 Colorado Ave Ste C Pueblo CO 81004-2008 Ph: (719) 696-9828 |
| NPI Number | 1346586088 |
|---|---|
| Provider Enumeration Date | 12/28/2012 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8628214830 |
|---|---|
| Medicare Enrollment ID | O20130412000579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346586088 | NPI | - | NPPES |
| 29732581 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 44011 (Colorado) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | 44011 (Colorado) | Primary |
| Provider Name | Jamie M Pollock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356470876 PECOS PAC ID: 0547351314 Enrollment ID: I20070808000351 |
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