Colorado Adult Primary Care | |
111 W Evans Ave Pueblo CO 81004-4215 | |
(719) 542-1000 | |
(719) 544-0098 |
Full Name | Colorado Adult Primary Care |
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Speciality | Family Medicine |
Location | 111 W Evans Ave, Pueblo, Colorado |
Authorized Official Name and Position | Christopher Dean Trujillo (OWNER/PROVIDER) |
Authorized Official Contact | 7195421000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Colorado Adult Primary Care 111 W Evans Ave Pueblo CO 81004-4215 Ph: (719) 542-1000 | Colorado Adult Primary Care 111 W Evans Ave Pueblo CO 81004-4215 Ph: (719) 542-1000 |
NPI Number | 1548761430 |
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Provider Enumeration Date | 02/26/2018 |
Last Update Date | 04/18/2019 |
Medicare PECOS PAC ID | 1658635933 |
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Medicare Enrollment ID | O20180515000187 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548761430 | NPI | - | NPPES |
98455079 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 0090638 (Colorado) | Primary |
Provider Name | Christopher Dean Trujillo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518206531 PECOS PAC ID: 0446481683 Enrollment ID: I20180515000278 |
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