| Pueblo Family Medicine, Pc | |
|
1600 N Grand Ave Ste 310 Pueblo CO 81003-2729 | |
| (719) 542-0072 | |
| (719) 542-9888 |
| Full Name | Pueblo Family Medicine, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 N Grand Ave Ste 310, Pueblo, Colorado |
| Authorized Official Name and Position | Gregory W Berens (PRESIDENT) |
| Authorized Official Contact | 7195420072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Family Medicine, Pc 1600 N Grand Ave Ste 310 Pueblo CO 81003-2729 Ph: (719) 542-0072 | Pueblo Family Medicine, Pc 1600 N Grand Ave Ste 310 Pueblo CO 81003-2729 Ph: (719) 542-0072 |
| NPI Number | 1114149986 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 01/22/2010 |
| Medicare PECOS PAC ID | 1456327006 |
|---|---|
| Medicare Enrollment ID | O20040907000228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114149986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Colorado) | Primary |
| Provider Name | Gregory W Berens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245295013 PECOS PAC ID: 6709941560 Enrollment ID: I20090211000762 |
| Provider Name | Guy L Kemling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154386795 PECOS PAC ID: 4486812666 Enrollment ID: I20120220000230 |
| Provider Name | Harry R Keefe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558326264 PECOS PAC ID: 0143483214 Enrollment ID: I20120530000271 |
| Provider Name | Nancy S Chuch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154386365 PECOS PAC ID: 8729241807 Enrollment ID: I20120530000334 |
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