| University Family Medicine Center, P.c. | |
|
4020 Jerry Murphy Rd Pueblo CO 81001-1045 | |
| (719) 546-3600 | |
| (719) 546-0931 |
| Full Name | University Family Medicine Center, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4020 Jerry Murphy Rd, Pueblo, Colorado |
| Authorized Official Name and Position | Tammy J Espinoza (OFFICE MANAGER) |
| Authorized Official Contact | 7195463600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Family Medicine Center, P.c. 4020 Jerry Murphy Rd Pueblo CO 81001-1045 Ph: (719) 546-3600 | University Family Medicine Center, P.c. 4020 Jerry Murphy Rd Pueblo CO 81001-1045 Ph: (719) 546-3600 |
| NPI Number | 1295807543 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 03/23/2021 |
| Medicare PECOS PAC ID | 9739157827 |
|---|---|
| Medicare Enrollment ID | O20040916001247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295807543 | NPI | - | NPPES |
| 04012381 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 27511 (Colorado) | Primary |
| 207Q00000X | Family Medicine | 30639 (Colorado) | Secondary |
| Provider Name | Lawrence C Anaya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245395649 PECOS PAC ID: 3476634809 Enrollment ID: I20120514000667 |
| Provider Name | Cheryl Wills |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609931013 PECOS PAC ID: 9537240965 Enrollment ID: I20120516000160 |
| Provider Name | Gwynn Antonson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700043692 PECOS PAC ID: 2567622103 Enrollment ID: I20130717000834 |
| Provider Name | Marissa E Shisler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760999692 PECOS PAC ID: 9638505928 Enrollment ID: I20200205000439 |
| Provider Name | Laura Ann Mcmahon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609008796 PECOS PAC ID: 8628404522 Enrollment ID: I20200213001500 |
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