Southern Colorado Clinic PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SOUTHERN COLORADO CLINIC PC

Practice address

2403 Santa Fe Dr Ste 7
Pueblo, CO 81006-1497

Phone

(719) 553-2200

NPI assigned

Mar 21, 2024

Organization subpart

Yes

Parent organization

SOUTHERN COLORADO CLINIC PCAs reported in NPPES

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

Authorized official

Name

Evangeline (Evie) Harris

Title

Credentialing Specialist

Phone

(719) 553-1804

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Tax ID family

Pueblo Physicians PC6 organizations share this tax ID, including this one

Part of

Pueblo Physicians PC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Colorado Clinic

  • Durable Medical Equipment & Medical Supplies
  • Pueblo, CO
  • NPI 1659435535
  NPD tax ID
• Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo, CO
  • NPI 1598371056
  NPD tax ID
• Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo, CO
  • NPI 1619562824
  NPD tax ID
• Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo, CO
  • NPI 1790677680
  NPD tax ID
• Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo West, CO
  • NPI 1831705300
  NPD tax ID

Locations

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

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1528828837",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 SANTA FE DR STE 7",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810061497",
            "telephone_number": "719-553-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN COLORADO CLINIC PC",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "EVANGELINE (EVIE)",
        "authorized_official_title_or_position": "CREDENTIALING  SPECIALIST",
        "authorized_official_telephone_number": "719-553-1804"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Pueblo Dental Partners LLP
• South Pueblo Medical Investors, LLC
• Southern Colorado Anesthesia Professional LLC
• Southern Colorado Clinic
• Southern Colorado Clinic PC
• Southern Colorado Clinic PC
• Southern Colorado Clinic PC
• Southern Colorado Clinic PC
• Southern Colorado Comprehensive Court Services
• Southern Colorado Counseling and Wellness. PLLC

• Clinic/Center in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.