Infectious Disease Specialist of Southern Colorado, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

DR51262 Issued in CO

Legal business name

INFECTIOUS DISEASE SPECIALIST OF SOUTHERN COLORADO, PLLC

Practice address

2001 Lake Ave
Suite 2
Pueblo, CO 81004-3538

Phone

(719) 582-8425

Fax

(888) 719-1380

NPI assigned

Oct 24, 2012

Last updated

Jan 29, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Victor Nwanguma, M.D

Title

Ceo

Phone

(719) 582-8425

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674950400000",
    "number": "1922351279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470238",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800470238",
            "telephone_number": "719-582-8425",
            "fax_number": "888-719-1380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 LAKE AVE",
            "address_2": "SUITE 2",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043538",
            "telephone_number": "719-582-8425",
            "fax_number": "888-719-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFECTIOUS DISEASE SPECIALIST OF SOUTHERN COLORADO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2023-01-29",
        "certification_date": "2023-01-29",
        "status": "A",
        "authorized_official_last_name": "NWANGUMA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-582-8425",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CO",
            "license": "DR51262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1336601387",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Jan 29, 2023; 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.