# UROLOGY OF SOUTHERN COLORADO PLLC

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

## Provider details

- **NPI number:** 1104001379
- **Authorized official:** DANA JOAN WEAVER-OSTERHOLTZ M.D. (OWNER)
- **Authorized official phone:** (719) 676-3728

## Contact information

- **Practice address:** 3676 PARKER BLVD, SUITE 310, PUEBLO, CO 81008-2212
- **Practice address phone:** (719) 545-1500
- **Mailing address:** 3676 PARKER BLVD, SUITE 310, PUEBLO, CO 81008-2212
- **Mailing address phone:** (719) 545-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 40134 | CO | Yes |

## Other

- **Enumeration date:** 01/07/2008
- **Last updated:** 10/15/2009