NPIMap

Organization Active NPI

C. Glen Ferguson D.O. P.C.

  • Anesthesiology Physician
  • Pueblo, CO
National Provider Identifier
1710105333
Registry record updated Jan 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
17205 Issued in CO
Legal business name
C. GLEN FERGUSON D.O. P.C.
Practice address
1615 Bonforte Blvd
Pueblo, CO 81001-1602
Phone
(719) 296-5840
Fax
(719) 542-0746
NPI assigned
Apr 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2008

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

Authorized official

Name
C. Glen Ferguson, D.O.NPI 1245330141
Title
Physician
Phone
(719) 296-5840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 17205 CO Primary

Addresses

Primary practice location

1615 Bonforte Blvd
Pueblo, CO 81001-1602

Mailing address

PO Box 570
Pueblo, CO 81002-0570
Phone (719) 296-5840

Other identifiers 2

IdentifierTypeStateIssuer
01172055MedicaidCO
FE03792OtherBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199664000000",
    "number": "1710105333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 570",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810020570",
            "telephone_number": "719-296-5840",
            "fax_number": "719-542-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 BONFORTE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011602",
            "telephone_number": "719-296-5840",
            "fax_number": "719-542-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C. GLEN FERGUSON D.O. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2008-01-07",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "719-296-5840",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "17205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01172055",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "FE03792",
            "state": null
        }
    ],
    "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 Jan 7, 2008; 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.