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General NPI Number Information
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NPI Number | 1912028564
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Entity Type | Organization
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Legal Business Name | SOUTHERN COLORADO PSYCHIATRIC P.C.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 1925 E ORMAN AVE STE G12
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City | PUEBLO
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State | CO
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Zip | 81004-3563
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Country | US
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Telephone | 719-564-1800
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Fax | 719-564-1865
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Provider Business Mailing Address
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Address Line | 1925 E ORMAN AVE STE G12
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City | PUEBLO
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State | CO
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Zip | 81004-3563
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Country | US
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Telephone | 719-564-1800
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Fax | 719-564-1865
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. MARY WRIGHT
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Credential |
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Telephone | 719-564-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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