Organization
PUEBLO COMMUNITY HEALTH CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD MOORE CEO (CEO)
(719) 543-8711
Entity
Organization
Contact information
Practice address
2030 LAKE AVENUE, PUEBLO, CO 81004
(719) 543-8711
(719) 543-5340
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8718
(719) 543-5340
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
0849
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05638275
—
CO
Enumeration date
06/18/2006
Last updated
09/23/2013
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