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Organization

CHILDREN'S CLINIC OF PUEBLO, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LORAINE L. CARROLL M.D. (PHYSICIAN)
(719) 295-2305
Entity
Organization

Contact information

Practice address
1600 N GRAND AVE, SUITE 240, PUEBLO, CO 81003-2700
(719) 295-2305
(719) 295-2320
Mailing address
1600 N GRAND AVE, SUITE 240, PUEBLO, CO 81003-2700
(719) 295-2305
(719) 295-2320

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36942
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
49708864
CO
01
CH636086
BCBS
Enumeration date
01/15/2007
Last updated
12/09/2011
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