Provider Demographics
NPI:1437175627
Name:PUEBLO ENDOSCOPY SUITES, LLC
Entity Type:Organization
Organization Name:PUEBLO ENDOSCOPY SUITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-3500
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2700
Mailing Address - Country:US
Mailing Address - Phone:719-546-2500
Mailing Address - Fax:719-546-2335
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-546-2500
Practice Address - Fax:719-546-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0754261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy