| |
405 W 15th St Ste 210 Pueblo CO 81003-2743 | |
(719) 584-7300 | |
(719) 595-7059 |
Full Name | |
---|---|
Speciality | Clinic/center |
Location | 405 W 15th St Ste 210, Pueblo, Colorado |
Authorized Official Name and Position | Jana Conroy (DIRECTOR OF CREDENTIALING) |
Authorized Official Contact | 7195847300 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 Ph: () - | 405 W 15th St Ste 210 Pueblo CO 81003-2743 Ph: (719) 584-7300 |
NPI Number | 1578308136 |
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Provider Enumeration Date | 06/26/2024 |
Last Update Date | 12/02/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578308136 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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