NPIMap

Organization Active NPI

Pueblo Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Pueblo, CO
National Provider Identifier
1770529950
Registry record updated Mar 9, 2026
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
300 Colorado Ave
Pueblo, CO 81004-2006
Phone
(719) 543-8711
Fax
(719) 543-5340
NPI assigned
Jun 22, 2006
Last updated
Mar 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

300 Colorado Ave
Pueblo, CO 81004-2006

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
05638275MedicaidCO

Other names 1

  • Colorado Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000171 CO Part B Supplier - Clinic/Group Practice 4284543802 Receives reassigned benefits from 167 practitioners
1 other NPI on this enrollment
Practice locations: Pueblo, CO; Walsenburg, CO; Avondale, CO
O20091116000473 CO Part A Provider - Federally Qualified Health Center (FQHC) 4284543802 Practice locations: Pueblo, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770529950. Details of each certification follow.

Federally qualified health center certification: CCN 061830

Legal name
PUEBLO COMMUNITY HEALTH CENTER INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 24, 1983 in CO
Enrollment address
300 Colorado Ave
Pueblo, CO 81004-2006

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Louis B. Balizet Individual Other Oct 1, 2017
M. Donald Ortega Individual Other Mar 1, 2018
Rosina Y Beascochea Individual Other May 1, 2018
Arthur L Yarbrough Individual Other Aug 1, 2014
Steven Shirley Individual Other Dec 1, 2019
Donald Moore Individual 5% Or Greater Indirect Ownership Interest Oct 2, 2009
Corporate OfficerChief Executive Officer Oct 2, 2009
Shirley Cordova Individual Other Jun 1, 2013
Phillip Lee Davis Individual Corporate DirectorChief Financial Officer Nov 4, 2020
W-2 Managing EmployeeChief Financial Officer Nov 4, 2020
Operational/Managerial ControlChief Financial Officer Nov 4, 2020
Sandra K Leming Individual Other May 1, 2021
Michael Gage Individual Other Apr 1, 2017
Linda Rikhoff Individual Other Jun 1, 2017

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pueblo Community Health CenterPueblo, CO, CCN 061031 Federally qualified health center Other May 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 174

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 174

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": "1773014400000",
    "number": "1770529950",
    "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": "719-585-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042006",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "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": "Colorado Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.