SOCO PRIMARY CARE CLINIC NPI 1124677729

NPI Information

SOCO PRIMARY CARE CLINIC is an adult health nurse practitioner in Pueblo, CO. SOCO PRIMARY CARE CLINIC NPI is 1124677729. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1310 FORTINO BLVD STE D
PUEBLO, CO
ZIP 81008-076
Phone: (719) 582-1898
Fax: (719) 621-4098

The provider's authorized official is Nicole Lynn Betts .
The authorized official title is President, Authorized Official and has the following contact phone number (719) 582-1898.

The CLIA number assigned to this NPI record is 06D2173237 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/6/2019 and was last updated on 4/30/2020.

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:

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