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SOUTHERN COLORADO NEPHROLOGY ASSOC PC NPI 1083642144


NPI Information

NPI: 1083642144
Provider Name: SOUTHERN COLORADO NEPHROLOGY ASSOC PC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 06D0517991

Address:
3426 LAKE AVE
120
PUEBLO, CO
ZIP 81004
Phone: (719) 561-5264
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SOUTHERN COLORADO NEPHROLOGY ASSOC PC is a specialist in Pueblo, CO. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHERN COLORADO NEPHROLOGY ASSOC PC NPI is 1083642144. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3426 LAKE AVE
120
PUEBLO, CO
ZIP 81004-877
Phone: (719) 561-5264
Fax: (719) 561-5272

The provider's authorized official is Juliette Giebel .
The authorized official title is Office Manager and has the following contact phone number (719) 561-5264.

The CLIA number assigned to this NPI record is 06D0517991 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/29/2006 and was last updated on 11/2/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CA1108MEDICARE PIN
204006250MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.