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Organization
CHAMPIONS FAMILY MEDICAL, PLLC
Active
Organization
CHAMPIONS FAMILY MEDICAL, PLLC
Active
Other names
Champions Family Medical
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD B LANE (PRACTICE MANAGER)
(719) 406-9304
Entity
Organization
Contact information
Practice address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 924-8448
(719) 924-9382
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 924-8448
(719) 924-9382
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
NULL
173000000X
Legal Medicine
Primary
—
—
Other
Enumeration date
01/17/2017
Last updated
01/17/2017
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