Provider Demographics
NPI:1245228022
Name:PUEBLO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Entity Type:Organization
Organization Name:PUEBLO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Other - Org Name:PUEBLO CITY COUNTY HEALTH DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PUBLIC HEALTH MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-981-9985
Mailing Address - Street 1:101 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4103
Mailing Address - Country:US
Mailing Address - Phone:719-583-4300
Mailing Address - Fax:719-583-4527
Practice Address - Street 1:101 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4103
Practice Address - Country:US
Practice Address - Phone:719-583-4300
Practice Address - Fax:719-583-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04416095Medicaid
CO04005609Medicaid
COC30366Medicare ID - Type Unspecified