| Omnicare Health Solutions, Inc. | |
|
900 Indiana Ave Ste B Pueblo CO 81004-3767 | |
| (719) 568-8611 | |
| Not Available |
| Full Name | Omnicare Health Solutions, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 900 Indiana Ave Ste B, Pueblo, Colorado |
| Authorized Official Name and Position | Nicole Boggs (FNP-BC) |
| Authorized Official Contact | 7195688611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omnicare Health Solutions, Inc. 900 Indiana Ave Ste B Pueblo CO 81004-3767 Ph: (719) 568-8611 | Omnicare Health Solutions, Inc. 900 Indiana Ave Ste B Pueblo CO 81004-3767 Ph: (719) 568-8611 |
| NPI Number | 1528714979 |
|---|---|
| Provider Enumeration Date | 02/24/2022 |
| Last Update Date | 02/24/2022 |
| Medicare PECOS PAC ID | 7517337108 |
|---|---|
| Medicare Enrollment ID | O20221222001200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528714979 | NPI | - | NPPES |
| 15053065 | Other | CO | CAQH PROVIEW |
| 246844 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dawn L Evert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952397952 PECOS PAC ID: 1153340567 Enrollment ID: I20051115000774 |
| Provider Name | Nicole Boggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124615851 PECOS PAC ID: 4880008903 Enrollment ID: I20210202000909 |
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