| Dublin Primary Care Pc | |
|
2685 Dublin Blvd Colorado Springs CO 80918-1358 | |
| (719) 592-9890 | |
| (719) 598-2306 |
| Full Name | Dublin Primary Care Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 2685 Dublin Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Steven Luebbert (PRESIDENT) |
| Authorized Official Contact | 7195929890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dublin Primary Care Pc 2685 Dublin Blvd Colorado Springs CO 80918-1358 Ph: (719) 592-9890 | Dublin Primary Care Pc 2685 Dublin Blvd Colorado Springs CO 80918-1358 Ph: (719) 592-9890 |
| NPI Number | 1457389777 |
|---|---|
| Provider Enumeration Date | 06/28/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0941292635 |
|---|---|
| Medicare Enrollment ID | O20040401001051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457389777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (Colorado) | Primary |
| Provider Name | Bruce Loran Kautz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1083695316 PECOS PAC ID: 3577534148 Enrollment ID: I20040805000729 |
| Provider Name | Kristine M Frederick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063503720 PECOS PAC ID: 7214990423 Enrollment ID: I20041109000544 |
| Provider Name | Shane E Mccarthy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629073150 PECOS PAC ID: 8527960962 Enrollment ID: I20070425000656 |
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