Pueblo Sports And Family Medicine Pllc | |
1315 Fortino Blvd Ste C Pueblo CO 81008-1981 | |
(719) 544-2740 | |
Not Available |
Full Name | Pueblo Sports And Family Medicine Pllc |
---|---|
Speciality | Family Medicine |
Location | 1315 Fortino Blvd Ste C, Pueblo, Colorado |
Authorized Official Name and Position | Rakesh Khosla (PRESIDENT) |
Authorized Official Contact | 7195442740 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Pueblo Sports And Family Medicine Pllc 1315 Fortino Blvd Ste C Pueblo CO 81008-1981 Ph: (719) 544-2740 | Pueblo Sports And Family Medicine Pllc 1315 Fortino Blvd Ste C Pueblo CO 81008-1981 Ph: (719) 544-2740 |
NPI Number | 1225525132 |
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Provider Enumeration Date | 04/16/2018 |
Last Update Date | 04/22/2018 |
Medicare PECOS PAC ID | 5991060253 |
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Medicare Enrollment ID | O20180607002142 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225525132 | NPI | - | NPPES |
0004910 | Other | CO | PA NUMBER |
1268788 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QS0010X | Family Medicine - Sports Medicine | 543004 (Colorado) | Primary |
Provider Name | Rakesh Kumar Khosla |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1952466336 PECOS PAC ID: 1355422783 Enrollment ID: I20100730000429 |
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