| |
311 W 14th St Pueblo CO 81003-2705 | |
(719) 595-7585 | |
(719) 595-7589 |
Full Name | |
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Speciality | Family Medicine - Adult Medicine |
Location | 311 W 14th St, Pueblo, Colorado |
Authorized Official Name and Position | Jana Conroy (DIRECTOR OF CREDENTIALING) |
Authorized Official Contact | 7195957585 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 Ph: () - | 311 W 14th St Pueblo CO 81003-2705 Ph: (719) 595-7585 |
NPI Number | 1104462597 |
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Provider Enumeration Date | 11/21/2019 |
Last Update Date | 12/03/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104462597 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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