NPIMap

Organization Active NPI

Pueblo Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Avondale, CO
National Provider Identifier
1821010448
Registry record updated Nov 6, 2025
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
328 Avondale Blvd
Avondale, CO 81022
Phone
(719) 543-8711
Fax
(719) 543-5340
NPI assigned
Jul 24, 2006
Last updated
Nov 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Authorized official

Name
Mr. Donald Moore, CEO
Title
Ceo
Phone
(719) 543-8711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0849 CO Primary

Addresses

Primary practice location

328 Avondale Blvd
Avondale, CO 81022

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091116000620 CO Part A Provider - Federally Qualified Health Center (FQHC) 4284543802 Practice locations: Avondale, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821010448. Details of each certification follow.

Federally qualified health center certification: CCN 061832

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
328 Avondale Blvd
Avondale, CO 81022-5005

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Pueblo Community Health17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

310 Colorado Ave
Pueblo, CO 81004

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rosina Y Beascochea Individual Corporate DirectorBoard Member May 1, 2018
Richard Duran Individual Corporate Director Jul 1, 2023
Steven Shirley Individual Corporate Director Dec 1, 2019
Fabian Sigala-Orozco Individual Corporate Director Jan 1, 2025
Donald Moore Individual Corporate Officer Oct 2, 2009
W-2 Managing Employee Oct 2, 2009
Operational/Managerial Control Oct 2, 2009
Laura Stein Individual Corporate Director Dec 1, 2024
Phillip Lee Davis Individual Corporate OfficerChief Financial Officer Nov 4, 2020
W-2 Managing EmployeeChief Financial Officer Nov 4, 2020
Operational/Managerial ControlChief Financial Officer Nov 4, 2020
Alexis Stewart Individual Corporate Director May 1, 2023
Tracy Phillips Individual Corporate DirectorBoard Director Jul 1, 2022
Ben Strand Individual Corporate Director Feb 1, 2024
Michael Gage Individual Corporate Director Apr 1, 2017
Teri E. Weldon Individual Corporate Director Sep 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1821010448",
    "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": "328 AVONDALE BLVD",
            "city": "AVONDALE",
            "state": "CO",
            "postal_code": "81022",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-543-8711",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, CO

Sources for this page

Verify at the official NPI Registry.