Soco Primary Care Clinic

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

SOCO PRIMARY CARE CLINIC

Practice address

1310 Fortino Blvd Ste D
Pueblo, CO 81008-2076

Phone

(719) 582-1898

Fax

(719) 621-4098

NPI assigned

Sep 6, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Lynn Betts, NP, AGNP-CNPI 1417327461

Title

President, Authorized Official

Phone

(719) 582-1898

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Betts, AGNP-C

  • Primary Care Nurse Practitioner
  • Pueblo, CO
  • NPI 1417327461

  Adult Health

  Medicare reassignment Care Compare group NPD Authorized official
• Chelsea L Frey, RN, MSN, NP-C

  • Primary Care Nurse Practitioner
  • Pueblo, CO
  • NPI 1588223598

  Adult Health

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1124677729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 FORTINO BLVD STE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082076",
            "telephone_number": "719-582-1898",
            "fax_number": "719-621-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCO PRIMARY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-06",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "BETTS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "719-582-1898",
        "authorized_official_credential": "NP, AGNP-C"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teneisha Smith
• Deborah Snell
• Shannon Snow, P.T.
• So-Co Property Maintenance LLC
• Soco Ophthalmology LLC
• Zoe D Soderstrom, COTA/L
• Muhammad Sohaib, M.D.
• George Glenn Solano, CAC III
• Judith A Solano
• Stephanie Solano

• Adult Health Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Adult Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.