Provider Demographics
NPI:1639619620
Name:COMPLETE EMERGENCY CARE PUEBLO LLC
Entity Type:Organization
Organization Name:COMPLETE EMERGENCY CARE PUEBLO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAXTON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-421-0031
Mailing Address - Street 1:PO BOX 93323
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0113
Mailing Address - Country:US
Mailing Address - Phone:817-421-0012
Mailing Address - Fax:817-421-0036
Practice Address - Street 1:2035 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2577
Practice Address - Country:US
Practice Address - Phone:817-527-3431
Practice Address - Fax:817-527-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care