# PEDIATRIC ASSOCIATES OF SOUTHERN COLORADO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023234861
- **Authorized official:** PUDUPAKKAM K VEDANTHAN M.D. (PRESIDENT)
- **Authorized official phone:** (303) 238-0471

## Contact information

- **Practice address:** 1312 N GRAND AVE, PUEBLO, CO 81003-2718
- **Practice address phone:** (719) 544-2090
- **Practice address fax:** (719) 544-2094
- **Mailing address:** 2020 WADSWORTH BLVD, SUITE 13A, LAKEWOOD, CO 80214-5728
- **Mailing address phone:** (303) 238-0471
- **Mailing address fax:** (303) 238-6711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 09/11/2025