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General NPI Number Information
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NPI Number | 1790608776
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Entity Type | Organization
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Legal Business Name | PUEBLO COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 1100 CARSON AVENUE STE SPECIALTY CLINIC
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City | LA JUNTA
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State | CO
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Zip | 81050
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Country | US
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Telephone | 719-543-8711
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Fax | 719-543-0171
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Provider Business Mailing Address
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Address Line | 110 E ROUTT AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2117
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Country | US
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Telephone | 719-543-8711
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Fax | 719-585-3057
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | PHILLIP L DAVIS
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Credential |
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Telephone | 719-543-8718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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