Pueblo Ear Nose & Throat Specialist

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

PUEBLO EAR NOSE & THROAT SPECIALIST

Practice address

1218 Pueblo Blvd Way
Pueblo, CO 81005-1507

Phone

(719) 566-1277

Fax

(719) 566-1257

NPI assigned

Dec 18, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Charlene Hickson, M.D.

Title

Owner

Phone

(719) 566-1277

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1306175484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 PUEBLO BLVD WAY",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051507",
            "telephone_number": "719-566-1277",
            "fax_number": "719-566-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 PUEBLO BLVD WAY",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051507",
            "telephone_number": "719-566-1277",
            "fax_number": "719-566-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO EAR NOSE & THROAT SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-18",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "HICKSON",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-566-1277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74482581",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pueblo Dental & Braces
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• Pueblo Dental Services LLC
• Pueblo Department of Public Health and Environment
• Pueblo Diversified Industries, Inc.
• Pueblo Endodontic Asso LLC
• Pueblo Endoscopy Suites, LLC
• Pueblo ER Physicians LLC
• Pueblo Family Dentistry PLLC
• Pueblo Family Medicine, PC

• Otolaryngology Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Otolaryngology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.