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General NPI Number Information
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NPI Number | 1306184056
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Entity Type | Organization
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Legal Business Name | AFFORDABLE HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 900 INDIANA AVE ST D
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City | PUEBLO
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State | CO
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Zip | 81004-8100
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Country | US
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Telephone | 719-924-9021
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Fax | 719-924-9166
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Provider Business Mailing Address
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Address Line | 900 INDIANA AVE ST D
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City | PUEBLO
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State | CO
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Zip | 81004-7503
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Country | US
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Telephone | 719-924-9021
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Fax | 719-924-9166
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DAWN LESLIE EVERT
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Credential | NP-C
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Telephone | 719-924-9021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 81123
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License Number State | CO
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