Provider Demographics
NPI:1356088595
Name:PUEBLO CHEMICAL AGENT-DESTRUCTION PILOT PLANT
Entity Type:Organization
Organization Name:PUEBLO CHEMICAL AGENT-DESTRUCTION PILOT PLANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:719-549-5483
Mailing Address - Street 1:45825 E STATE HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-9330
Mailing Address - Country:US
Mailing Address - Phone:719-549-5483
Mailing Address - Fax:
Practice Address - Street 1:45825 E STATE HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9330
Practice Address - Country:US
Practice Address - Phone:719-549-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine