Southern Colorado Clinic PC
Clinic/Center in Pueblo, CO. Organization (NPI-2).
NPI number1528828837
StatusActive
Last updated in NPPESMar 26, 2024
Details
- NPI
- 1528828837
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Colorado Clinic PC
- Organization subpart
- Yes
- Enumeration date
- Mar 21, 2024
- Certification date
- Mar 26, 2024
- Last updated
- Mar 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
2403 Santa Fe Dr Ste 7Pueblo, CO 81006-1497
Phone 719-553-2200
Mailing address
Po Box 9000Pueblo, CO 81008-9000
Phone 719-553-2200
Authorized official
Evangeline (Evie) Harris
Credentialing Specialist
7195531804
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