MEDICARE: PUEBLO COMMUNITY HEALTH CENTER INC

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1851235915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUEBLO COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	110 E ROUTT AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-2117
Country	:	US
Telephone Number	:	719-543-8711
Fax Number	:	719-585-3057

Provider Business Practice Location Address
First Line	:	710 W 4TH ST STE E&F
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2383
Country	:	US
Telephone Number	:	719-543-8711
Fax Number	:	719-543-0171

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	PHILLIP L DAVIS
Credential	:
Telephone Number	:	719-543-8718

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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