Provider Demographics
NPI:1720386139
Name:DONALD C. LUEBKE M.D. PC
Entity Type:Organization
Organization Name:DONALD C. LUEBKE M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CF
Authorized Official - Phone:719-544-7070
Mailing Address - Street 1:4100 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1046
Mailing Address - Country:US
Mailing Address - Phone:719-544-7070
Mailing Address - Fax:719-544-7011
Practice Address - Street 1:4100 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1046
Practice Address - Country:US
Practice Address - Phone:719-544-7070
Practice Address - Fax:719-544-7011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-09
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22132332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0731270001Medicare NSC