Provider Demographics
NPI:1083609796
Name:PUEBLO ASSOC IN OB & GYN PC
Entity Type:Organization
Organization Name:PUEBLO ASSOC IN OB & GYN PC
Other - Org Name:ASSOCIATES IN WOMENS HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MACRAE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-564-0660
Mailing Address - Street 1:1120 MINNEQUA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3734
Mailing Address - Country:US
Mailing Address - Phone:719-564-0660
Mailing Address - Fax:719-564-0037
Practice Address - Street 1:1120 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3734
Practice Address - Country:US
Practice Address - Phone:719-564-0660
Practice Address - Fax:719-564-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF7208Medicare ID - Type Unspecified