| Central High School Sbwc | |
|
216 E Orman Ave Pueblo CO 81004-2144 | |
| (719) 543-8711 | |
| (719) 543-0171 |
| Full Name | Central High School Sbwc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 216 E Orman Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Donald Moore (CEO) |
| Authorized Official Contact | 7195438711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central High School Sbwc 110 E Routt Ave Pueblo CO 81004-2117 Ph: (719) 543-8711 | Central High School Sbwc 216 E Orman Ave Pueblo CO 81004-2144 Ph: (719) 543-8711 |
| NPI Number | 1700139813 |
|---|---|
| Provider Enumeration Date | 10/26/2012 |
| Last Update Date | 06/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700139813 | NPI | - | NPPES |
| 04257871 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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