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General NPI Number Information
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NPI Number | 1023234861
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF SOUTHERN COLORADO, LLC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1312 N GRAND AVE
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City | PUEBLO
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State | CO
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Zip | 81003-2718
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Country | US
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Telephone | 719-544-2090
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Fax | 719-544-2094
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Provider Business Mailing Address
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Address Line | 2020 WADSWORTH BLVD SUITE 13A
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City | LAKEWOOD
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State | CO
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Zip | 80214-5728
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Country | US
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Telephone | 303-238-0471
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Fax | 303-238-6711
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Authorized Official
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Title or Position | PRESIDENT
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Name | PUDUPAKKAM K VEDANTHAN
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Credential | M.D.
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Telephone | 303-238-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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