NPI 1033430442

Colorado Department of Corrections

Organisation Exclusive Provider Organization Pueblo, CO

Practice location

Address: 1410 W 13th St, Pueblo, CO 81003-1961
Phone: (719) 583-5550
Fax: (719) 583-5525

Authorised official

Name: Joanie Shoemaker
Title: Director of Clinical Services
Phone: (719) 226-4535

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 19512 (CO)

Other Exclusive Provider Organization providers in Colorado →

Registry record

NPI: 1033430442
Entity type: Organization
NPI issued: 21 Jun 2010
Record last updated: 21 Jun 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.