Organization
PUEBLO COMMUNITY HEALTH CENTER INC
Active
Other names
Central High School SBWC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD MOORE (CEO)
(719) 543-8711
Entity
Organization
Contact information
Practice address
216 E ORMAN AVE, PUEBLO, CO 81004-2144
(719) 543-8711
(719) 543-0171
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-5340
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04257871
—
CO
Enumeration date
10/26/2012
Last updated
06/11/2021
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