Healthcare Provider Details

I. General information

NPI: 1811793904
Provider Name (Legal Business Name): SOUTHERN COLORADO EMERGENCY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

400 W 16TH ST
PUEBLO CO
81003-2745
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4306
  • Fax: 719-595-7893
Mailing address:
  • Phone: 719-584-4306
  • Fax: 719-595-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT T BECKER III
Title or Position: SCEMA PRESIDENT
Credential: MD
Phone: 719-584-4306