| Pueblo Community Health Center, Inc | |
|
1008 N Grand Ave Pueblo CO 81003-2916 | |
| (719) 543-8718 | |
| Not Available |
| Full Name | Pueblo Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1008 N Grand Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Donald Moore (CEO) |
| Authorized Official Contact | 7195438718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Community Health Center, Inc 110 E Routt Ave Pueblo CO 81004-2117 Ph: (719) 543-8718 | Pueblo Community Health Center, Inc 1008 N Grand Ave Pueblo CO 81003-2916 Ph: (719) 543-8718 |
| NPI Number | 1144589425 |
|---|---|
| Provider Enumeration Date | 05/08/2012 |
| Last Update Date | 09/06/2013 |
| Medicare PECOS PAC ID | 4284543802 |
|---|---|
| Medicare Enrollment ID | O20130603000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144589425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 180635 (Colorado) | Primary |
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