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Organization
PEDIATRIC ASSOCIATES OF SOUTHERN COLORADO, LLC
Active
Organization
PEDIATRIC ASSOCIATES OF SOUTHERN COLORADO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PUDUPAKKAM K VEDANTHAN M.D. (PRESIDENT)
(303) 238-0471
Entity
Organization
Contact information
Practice address
1312 N GRAND AVE, PUEBLO, CO 81003-2718
(719) 544-2090
(719) 544-2094
Mailing address
2020 WADSWORTH BLVD, SUITE 13A, LAKEWOOD, CO 80214-5728
(303) 238-0471
(303) 238-6711
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
NULL
207K00000X
Allergy & Immunology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
04/18/2007
Last updated
09/11/2025
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