| Pueblo Community Health Center Inc. | |
|
2030 Lake Avenue Pueblo CO 81004 | |
| (719) 543-8711 | |
| (719) 543-5340 |
| Full Name | Pueblo Community Health Center Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2030 Lake Avenue, 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 |
|---|---|
| Pueblo Community Health Center Inc. 110 E Routt Ave Pueblo CO 81004-2117 Ph: (719) 543-8718 | Pueblo Community Health Center Inc. 2030 Lake Avenue Pueblo CO 81004 Ph: (719) 543-8711 |
| NPI Number | 1245275932 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 09/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245275932 | NPI | - | NPPES |
| 05638275 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0849 (Colorado) | Primary |
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