| 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 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 04/22/2018 |
| Medicare PECOS PAC ID | 5991060253 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952466336 PECOS PAC ID: 1355422783 Enrollment ID: I20100730000429 |
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