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General NPI Number Information
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NPI Number | 1811793904
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Entity Type | Organization
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Legal Business Name | SOUTHERN COLORADO EMERGENCY MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 400 W 16TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2745
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Country | US
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Telephone | 719-584-4306
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Fax | 719-595-7893
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Provider Business Mailing Address
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Address Line | 400 W 16TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2745
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Country | US
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Telephone | 719-584-4306
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Fax | 719-595-7893
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Authorized Official
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Title or Position | SCEMA PRESIDENT
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Name | ROBERT T BECKER III
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Credential | MD
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Telephone | 719-584-4306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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