PUEBLO FAMILY MEDICINE PC NPI 1114149986

NPI Information

NPI: 1114149986
Provider Name: PUEBLO FAMILY MEDICINE, PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 06D1018849

Address:
1600 N GRAND AVE STE 310
PUEBLO, CO
ZIP 81003
Phone: (719) 542-0072
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PUEBLO FAMILY MEDICINE, PC is a primary care clinic center in Pueblo, CO. PUEBLO FAMILY MEDICINE, PC NPI is 1114149986. The provider is registered as an organization entity type.

The provider's business location address is:

1600 N GRAND AVE STE 310
PUEBLO, CO
ZIP 81003-729
Phone: (719) 542-0072
Fax: (719) 542-9888

The provider's authorized official is Gregory W Berens .
The authorized official title is President and has the following contact phone number (719) 542-0072.

The CLIA number assigned to this NPI record is 06D1018849 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2007 and was last updated on 1/22/2010.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care		COLORADO	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	390708	MEDICARE ID-TYPE UNSPECIFIED	COLORADO

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

NPI Synchronization or Removal

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