Healthcare Provider Details

I. General information

NPI: 1306274378
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

IV. Provider business mailing address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-5710
  • Fax: 303-649-5877
Mailing address:
  • Phone: 303-649-5710
  • Fax: 303-649-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number1680000042
License Number StateCO

VIII. Authorized Official

Name: DENESE CLARK
Title or Position: REGIONAL ADMINISTRATOR
Credential:
Phone: 303-326-6717