PUEBLO WEST PRIMARY CARE LLC (NPI# 1659939403) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659939403 |
| Entity Type | Organization |
| Organization Name | PUEBLO WEST PRIMARY CARE LLC |
| Other Organization Name | PUEBLO WEST PRIMARY CARE |
| Practice Address |
141 S Purcell Blvd Ste 140 Pueblo West CO 81007-5123 |
| Practice Telephone | 7192819587 |
| Practice Fax Number | 7199602054 |
| Mailing Telephone | 7192819587 |
| Mailing Fax Number | 7199602054 |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-10-29 |
| Authorized Official Name | TERRI SHAWCROFT (OFFICE MANAGER) |
| Authorized Official Telephone | 7192519465 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pueblo West Primary Care | Doing Business As Name - Organization |
| Street Address |
141 S PURCELL BLVD STE 140 |
| City | PUEBLO WEST |
| State | CO |
| Zip Code | 81007-5123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730794892 | Julie Marie Keehn | Nurse Practitioner | 141 S Purcell Blvd Ste 140, Pueblo West, CO 81007-5123 | 2020-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811406630 | Southern Colorado Hearing Associates, Inc. | Audiologist | 904 East Hailey Lane, Pueblo West, CO 81007 | 2017-09-25 |
| 1396274361 | Laura Selig | Physical Therapist | 1168 N Thorpe Dr, Pueblo West, CO 81007 | 2017-06-05 |
| 1710351127 | Benjamin Gaines | Speech-Language Pathologist | 1056 W Broken Bow Dr, Pueblo West, CO 81007 | 2015-11-23 |
| 1467861351 | Zoe Grillos | Massage Therapist | 876 S Knox Dr, Pueblo West, CO 81007 | 2014-08-05 |
| 1033454186 | Melissa Lynn Hollis | Occupational Therapy Assistant | 1333 N Blue Lake Ln, Pueblo West, CO 81007 | 2012-11-30 |
| 1336491125 | Patricia Deana Cuadrado | General Practice | 44 E. Spaulding Ave., Pueblo West, CO 81007 | 2012-10-04 |
| 1194088021 | Aaron J Wilson | Chiropractor | 50 S Dunlap Dr, Pueblo West, CO 81007 | 2012-06-15 |
| 1780811893 | Rhonda Renee Grigg | Pediatrics | 332 S Orchard Springs Dr. 150, Pueblo, CO 81007 | 2009-06-16 |
| 1144482191 | Christopher Nicholas Liontas | Dentist | 360 S. Orchard Springs Dr, Pueblo West, CO 81007 | 2008-07-01 |
| 1780855718 | Justin Dean Youngren | Chiropractor | 50 S Dunlap Drive, Pueblo West, CO 81007 | 2008-03-18 |
| Find all providers in zip 81007 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023290707 | Donald F Benton | Family Medicine | 121 S. Crescent Drive, Suite B, Pueblo West, CO 81007-5433 | 2007-12-04 |
| 1922000421 | Star Rehab Prof Physicians, LLC | Family Medicine | 201 S Mcculloch Blvd, Pueblo West, CO 81007-2892 | 2005-08-15 |
| 1104821826 | John Todd White | Family Medicine | 729 E Spaulding Ave, Pueblo West, CO 81007-3512 | 2005-06-17 |
| 1144828401 | Boondocs Medical Services, LLC | Family Medicine | 1021 N Market Plz, Pueblo West, CO 81007-1531 | 2020-10-09 |
| 1386256873 | Catholic Health Initiatives Colorado | Family Medicine | 729 E Spaulding Ave, Pueblo West, CO 81007-3512 | 2020-08-18 |
| 1902440597 | Parkview Ancillary Services | Family Medicine | 121 S. Crescent Drive, Pueblo West, CO 81007-5434 | 2019-11-06 |
| 1063868578 | Abner Fernandez | Family Medicine | 121 S. Crescent Drive, Pueblo West, CO 81007-5434 | 2016-05-13 |
| 1225324361 | Christopher Ryan Boone | Family Medicine | 121 S. Crescent Drive, Pueblo West, CO 81007-5434 | 2011-06-28 |
| 1407063563 | Dana R Bennett Md PC | Family Medicine | 121 S Crescent Dr, Pueblo West, CO 81007-5433 | 2007-05-17 |
| 1275753519 | Dana Ransom Bennett | Family Medicine | 121 S Crescent Dr, Pueblo West, CO 81007-5433 | 2007-04-27 |
| Find all providers in PUEBLO WEST | ||||
| City | PUEBLO WEST |
| Zip Code | 81007 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.