Provider Demographics
NPI:1265578249
Name:PUEBLO SCHOOL DISTRICT 60
Entity type:Organization
Organization Name:PUEBLO SCHOOL DISTRICT 60
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COORDINATED SCHOOL HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-549-7154
Mailing Address - Street 1:315 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2804
Mailing Address - Country:US
Mailing Address - Phone:719-549-7154
Mailing Address - Fax:719-549-7183
Practice Address - Street 1:315 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2804
Practice Address - Country:US
Practice Address - Phone:719-549-7154
Practice Address - Fax:719-549-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79920756Medicaid