Provider Demographics
NPI:1922016393
Name:HOSPITALISTS OF PUEBLO
Entity Type:Organization
Organization Name:HOSPITALISTS OF PUEBLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-564-1542
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-0177
Mailing Address - Country:US
Mailing Address - Phone:719-561-8574
Mailing Address - Fax:719-564-9180
Practice Address - Street 1:1930 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3553
Practice Address - Country:US
Practice Address - Phone:719-561-8574
Practice Address - Fax:719-564-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81882815Medicaid
CO81882815Medicaid