| |
4112 Outlook Blvd Ste 303 Pueblo CO 81008-1667 | |
(719) 557-8600 | |
(719) 557-8615 |
Full Name | |
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Speciality | Family Medicine |
Location | 4112 Outlook Blvd Ste 303, Pueblo, Colorado |
Authorized Official Name and Position | Angela Jo Skinner (ADMINISTRATOR OMA) |
Authorized Official Contact | 7206677283 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 800022 Kansas City MO 64180-0022 Ph: (800) 953-0104 | 4112 Outlook Blvd Ste 303 Pueblo CO 81008-1667 Ph: (719) 557-8600 |
NPI Number | 1346851268 |
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Provider Enumeration Date | 08/13/2020 |
Last Update Date | 06/24/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346851268 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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