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1619 N Greenwood St Ste 210 Pueblo CO 81003-2656 | |
| (719) 595-7760 | |
| (719) 595-7765 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1619 N Greenwood St Ste 210, Pueblo, Colorado |
| Authorized Official Name and Position | Jana Conroy (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 7195957760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 Ph: () - | 1619 N Greenwood St Ste 210 Pueblo CO 81003-2656 Ph: (719) 595-7760 |
| NPI Number | 1346970928 |
|---|---|
| Provider Enumeration Date | 06/15/2022 |
| Last Update Date | 12/02/2024 |
| Certification Date | 12/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346970928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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