Organization
PUEBLO COMMUNITY HEALTH CENTER INC
Active
Other names
Walsenburg Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD MOORE (CEO)
(719) 543-8718
Entity
Organization
Contact information
Practice address
129 KANSAS AVE, WALSENBURG, CO 81089-1818
(719) 738-2718
(719) 738-2732
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 585-3057
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
180635
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05638275
—
CO
Enumeration date
11/14/2007
Last updated
09/30/2021
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