NPIMap

Organization Active NPI

Pueblo Community Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Pueblo, CO
National Provider Identifier
1164468336
Registry record updated Sep 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0849 Issued in CO
Legal business name
PUEBLO COMMUNITY HEALTH CENTER INC.
Practice address
1302 E 5TH St
Pueblo, CO 81001-3754
Phone
(719) 543-8711
Fax
(719) 543-5340
NPI assigned
Jun 22, 2006
Last updated
Sep 24, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PUEBLO COMMUNITY HEALTH CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2013

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

Authorized official

Name
Mr. Donald E Moore, CEO
Title
Chief Executive Officer
Phone
(719) 543-8718

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0849 CO Primary

Addresses

Primary practice location

1302 E 5TH St
Pueblo, CO 81001-3754

Mailing address

110 E Routt Ave
Pueblo, CO 81004-2117
Phone (719) 543-8718

Other identifiers 1

IdentifierTypeStateIssuer
05638275MedicaidCO

Other names 1

  • Parkhill Clinic Other name

National Provider Directory

National Provider Directory
Part of
Pueblo Community Health Center Inc

Locations

1050 Lane 35
Pueblo, CO 81006
Phone (719) 948-3351

2525 Mountview Dr
Pueblo, CO 81008
Phone (719) 253-6112

900 W Orman Ave
Pueblo, CO 81004
Phone (719) 549-3269

900 W Orman Ave
#118
Pueblo, CO 81004

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1164468336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8718",
            "fax_number": "719-543-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 E 5TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810013754",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO COMMUNITY HEALTH CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUEBLO COMMUNITY HEALTH CENTER INC.",
        "enumeration_date": "2006-06-22",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "719-543-8718",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "0849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638275",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkhill Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.