# SOUTHERN COLORADO CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHERN COLORADO CLINIC PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1528828837
- **Legal business name:** SOUTHERN COLORADO CLINIC PC
- **Authorized official:** EVANGELINE (EVIE) HARRIS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (719) 553-1804

## Contact information

- **Practice address:** 2403 SANTA FE DR STE 7, PUEBLO, CO 81006-1497
- **Practice address phone:** (719) 553-2200
- **Mailing address:** PO BOX 9000, PUEBLO, CO 81008-9000
- **Mailing address phone:** (719) 553-2200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/21/2024
- **Last updated:** 03/26/2024