Healthcare Provider Details

I. General information

NPI: 1336365600
Provider Name (Legal Business Name): PUEBLO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W 12TH ST
PUEBLO CO
81003-2975
US

IV. Provider business mailing address

212 W 12TH ST
PUEBLO CO
81003-2975
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-6179
  • Fax: 719-583-6174
Mailing address:
  • Phone: 719-583-6179
  • Fax: 719-583-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHARON J ELLIS
Title or Position: CHIEF FINANCE OFFICER
Credential:
Phone: 719-583-6179