| Affordable Health Clinic, Llc | |
|
900 Indiana Ave St D Pueblo CO 81004-8100 | |
| (719) 924-9021 | |
| (719) 924-9166 |
| Full Name | Affordable Health Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 900 Indiana Ave St D, Pueblo, Colorado |
| Authorized Official Name and Position | Dawn Leslie Evert (OWNER) |
| Authorized Official Contact | 7199249021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affordable Health Clinic, Llc 900 Indiana Ave St D Pueblo CO 81004-7503 Ph: (719) 924-9021 | Affordable Health Clinic, Llc 900 Indiana Ave St D Pueblo CO 81004-8100 Ph: (719) 924-9021 |
| NPI Number | 1306184056 |
|---|---|
| Provider Enumeration Date | 01/30/2013 |
| Last Update Date | 10/06/2020 |
| Medicare PECOS PAC ID | 0840435582 |
|---|---|
| Medicare Enrollment ID | O20130328000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306184056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 81123 (Colorado) | Primary |
| Provider Name | Dawn L Evert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952397952 PECOS PAC ID: 1153340567 Enrollment ID: I20051115000774 |
| Provider Name | Nicole Boggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124615851 PECOS PAC ID: 4880008903 Enrollment ID: I20210202000909 |
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