Healthcare Provider Details

I. General information

NPI: 1639134505
Provider Name (Legal Business Name): PUEBLO AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONTEBELLO RD
PUEBLO CO
81001-1236
US

IV. Provider business mailing address

25 MONTEBELLO RD
PUEBLO CO
81001-1236
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-1600
  • Fax: 866-989-7184
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORICED OFFICIAL
Credential:
Phone: 314-800-2017