NPIMap

Organization Active NPI

Southern Colorado ENT & Allergy LLC

  • Specialist
  • Pueblo, CO
National Provider Identifier
1851412134
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
41367 Issued in CO
Legal business name
SOUTHERN COLORADO ENT & ALLERGY LLC
Practice address
3676 Parker Blvd Ste 320
Pueblo, CO 81008-2213
Phone
(719) 296-6989
Fax
(719) 296-6990
NPI assigned
Apr 3, 2007
Last updated
Jun 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Authorized official

Name
Robert C McLean, MD, PHD
Title
Owner, Provider
Phone
(719) 647-9286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 41367 CO Primary

Addresses

Primary practice location

3676 Parker Blvd Ste 320
Pueblo, CO 81008-2213

Mailing address

3676 Parker Blvd Ste 320
Pueblo, CO 81008-2213
Phone (719) 296-6989

Other identifiers 1

IdentifierTypeStateIssuer
35883545MedicaidCO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1851412134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD STE 320",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082213",
            "telephone_number": "719-296-6989",
            "fax_number": "719-296-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD STE 320",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082213",
            "telephone_number": "719-296-6989",
            "fax_number": "719-296-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO ENT & ALLERGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "MCLEAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER, PROVIDER",
        "authorized_official_telephone_number": "719-647-9286",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "41367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35883545",
            "state": "CO"
        }
    ],
    "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 Jun 13, 2011; 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.