Organization
PUEBLO COMMUNITY HEALTH CENTER INC
Active
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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