| Pueblo West Primary Care Llc | |
|
141 S Purcell Blvd Ste 140 Pueblo West CO 81007-5123 | |
| (719) 281-9587 | |
| (719) 960-2054 |
| Full Name | Pueblo West Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 141 S Purcell Blvd Ste 140, Pueblo West, Colorado |
| Authorized Official Name and Position | Terri Shawcroft (OFFICE MANAGER) |
| Authorized Official Contact | 7192519465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo West Primary Care Llc 141 S Purcell Blvd Ste 140 Pueblo West CO 81007-5123 Ph: (719) 281-9587 | Pueblo West Primary Care Llc 141 S Purcell Blvd Ste 140 Pueblo West CO 81007-5123 Ph: (719) 281-9587 |
| NPI Number | 1659939403 |
|---|---|
| Provider Enumeration Date | 06/05/2019 |
| Last Update Date | 10/29/2019 |
| Medicare PECOS PAC ID | 5991138802 |
|---|---|
| Medicare Enrollment ID | O20191207000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659939403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Merilee C Briggs Mead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710936968 PECOS PAC ID: 3072525070 Enrollment ID: I20060609000237 |
| Provider Name | Amanda C Fadenrecht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023425386 PECOS PAC ID: 9739309568 Enrollment ID: I20140930000996 |
| Provider Name | Julie M Keehn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730794892 PECOS PAC ID: 0941620413 Enrollment ID: I20201022000151 |
| Provider Name | Preston Heinen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205530573 PECOS PAC ID: 3971964966 Enrollment ID: I20230808000409 |
| Provider Name | Shelby Duffey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902675218 PECOS PAC ID: 5496191520 Enrollment ID: I20240312002570 |
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