MEDICARE: PUEBLO COMMUNITY HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	180635	CO

General Provider Information

NPI Number	:	1144589425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUEBLO COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	110 E ROUTT AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-2117
Country	:	US
Telephone Number	:	719-543-8718
Fax Number	:	719-543-5340

Provider Business Practice Location Address
First Line	:	1008 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2916
Country	:	US
Telephone Number	:	719-543-8718
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DONALD MOORE
Credential	:
Telephone Number	:	719-543-8718

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	09/06/2013

Similar Medicare Providers

1891721437 — LYNN R LEYBA NP, CNM
Practice Location Address:

1008 N GRAND AVE
PUEBLO, CO
81003-2916

Practice Phone: 719-543-8711
Practice Fax:

1427427939 — ALEXIS GANZ PSY.D.
Practice Location Address:

1300 W 13TH ST
PUEBLO, CO
81003-1975

Practice Phone: 719-544-4800
Practice Fax:

1811839012 — MRS. SHIRLEY JANE ESQUIBEL RN
Practice Location Address:

525 W 15TH ST # 200
PUEBLO, CO
81003-2716

Practice Phone: 719-296-6000
Practice Fax:

1891923033 — MARK EDWARD MAURER
Practice Location Address:

1619 N GREENWOOD ST , STE 300
PUEBLO, CO
81003-2644

Practice Phone: 719-543-2476
Practice Fax: 719-543-2479

1114541059 — JACALYN MARTINEZ M.S. CCC-SLP
Practice Location Address:

126 W D ST STE 100C
PUEBLO, CO
81003-4430

Practice Phone: 719-621-1182
Practice Fax: 719-931-5601

1649113358 — KRISTY DALTON
Practice Location Address:

101 W 9TH ST
PUEBLO, CO
81003-4103

Practice Phone: 719-583-4376
Practice Fax: 719-583-4375

Directions to “PUEBLO COMMUNITY HEALTH CENTER, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.