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NPI Code Detail

MEDICARE: PUEBLO MEDICAL INVESTORS, LLC

MEDICARE: PUEBLO MEDICAL INVESTORS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0004CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588673255
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUEBLO MEDICAL INVESTORS, LLC
Provider Business Mailing Address
First Line : 3001 KEITH ST NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3713
Country : US
Telephone Number : 423-473-5751
Fax Number : 423-339-8342
Provider Business Practice Location Address
First Line : 3701 W RADCLIFF AVE
Second Line :
City : DENVER
State : CO
Zip : 80236-3645
Country : US
Telephone Number : 303-794-6484
Fax Number : 303-797-8781
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : CINDY S CROSS
Credential :
Telephone Number : 423-473-5867
Provider Enumeration Date : 08/05/2006
Last Update Date : 09/15/2021

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Directions to “PUEBLO MEDICAL INVESTORS, LLC ” Practice Location

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