| Rocky Mountain Sports And Family Medicine At Centura | |
|
1315 Fortino Blvd Pueblo CO 81008-1981 | |
| (719) 557-8600 | |
| (719) 557-8615 |
| Full Name | Rocky Mountain Sports And Family Medicine At Centura |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 1315 Fortino Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Angela Skinner (OMA ADMINISTRATOR) |
| Authorized Official Contact | 3036737175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rocky Mountain Sports And Family Medicine At Centura Po Box 911057 Denver CO 80291-1057 Ph: (303) 643-1099 | Rocky Mountain Sports And Family Medicine At Centura 1315 Fortino Blvd Pueblo CO 81008-1981 Ph: (719) 557-8600 |
| NPI Number | 1205112596 |
|---|---|
| Provider Enumeration Date | 10/31/2011 |
| Last Update Date | 04/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205112596 | NPI | - | NPPES |
| 31436579 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
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