Organization
ADULT MEDICINE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SALLY K PRUTCH (OFFICE MANAGER)
(719) 546-3511
Entity
Organization
Contact information
Practice address
314 W 16TH ST, PUEBLO, CO 81003-2728
(719) 546-3511
(719) 583-1292
Mailing address
314 W 16TH ST, PUEBLO, CO 81003
(719) 546-3511
(719) 583-1292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23565
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04004313
—
CO
Enumeration date
04/16/2007
Last updated
06/13/2012
Update your record
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