| |
902 Lakeview Ave Pueblo CO 81004-3597 | |
(719) 557-5855 | |
(719) 557-4652 |
Full Name | |
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Speciality | Family Medicine |
Location | 902 Lakeview Ave, 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 |
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Po Box 911057 Denver CO 80291-1057 Ph: (303) 643-1099 | 902 Lakeview Ave Pueblo CO 81004-3597 Ph: (719) 557-5855 |
NPI Number | 1710933163 |
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Provider Enumeration Date | 05/26/2006 |
Last Update Date | 04/22/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710933163 | NPI | - | NPPES |
49735578 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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