Healthcare Provider Details

I. General information

NPI: 1871556597
Provider Name (Legal Business Name): SOUTHERN COLORADO WOMEN'S CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 N GREENWOOD ST
PUEBLO CO
81003-2644
US

IV. Provider business mailing address

1619 N GREENWOOD ST
PUEBLO CO
81003-2644
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-9010
  • Fax: 719-542-9012
Mailing address:
  • Phone: 719-542-9010
  • Fax: 719-542-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN LYNN KEY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 719-542-9010