NPIMap

Organization Active NPI

Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo, CO
National Provider Identifier
1285613554
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOUTHERN COLORADO CLINIC PC
Practice address
3676 Parker Blvd
Pueblo, CO 81008-2212
Phone
(719) 553-2200
Fax
(719) 553-2213
NPI assigned
Jan 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Authorized official

Name
Jennifer Arellano
Title
Coo
Phone
(719) 553-1801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3676 Parker Blvd
Pueblo, CO 81008-2212

Mailing address

PO Box 9000
Pueblo, CO 81008-9000
Phone (719) 553-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316001277 CO Part B Supplier - Clinic/Group Practice 4284524067 Receives reassigned benefits from 56 practitioners
Practice locations: Pueblo, CO; Pueblo West, CO

National Provider Directory

National Provider Directory

Locations

4112 Outlook Blvd
Ste 255290
Pueblo, CO 81008

3676 Parker Blvd
Ste 220
Pueblo, CO 81008

3776 Parker Blvd
Pueblo, CO 81008

4112 Outlook Blvd
Pueblo, CO 81008
Phone (719) 553-1000

3676 Parker Blvd
Ste 260
Pueblo, CO 81008
Phone (719) 553-2201

314 W 16th St
Pueblo, CO 81003
Phone (719) 546-3511

3676 Parker Blvd
Ste 290
Pueblo, CO 81008
Phone (719) 553-2200

3676 Parker Blvd
Ste 370
Pueblo, CO 81008
Phone (719) 553-2209

4112 Outlook Blvd
Ste 290
Pueblo, CO 81008
Phone (719) 553-2235

3676 Parker Blvd
Ste 230
Pueblo, CO 81008
Phone (719) 553-2200

Practitioners & affiliated clinicians

Practitioners 68

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

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1285613554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810089000",
            "telephone_number": "719-553-2200",
            "fax_number": "719-553-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082212",
            "telephone_number": "719-553-2200",
            "fax_number": "719-553-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A",
        "authorized_official_last_name": "ARELLANO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "719-553-1801"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.