Healthcare Provider Details

I. General information

NPI: 1174698435
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/23/2021
Certification Date: 05/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 BENT WAY
LONGMONT CO
80503-7614
US

IV. Provider business mailing address

2345 BENT WAY
LONGMONT CO
80503-7614
US

V. Phone/Fax

Practice location:
  • Phone: 303-678-3300
  • Fax: 303-678-3302
Mailing address:
  • Phone: 303-678-3300
  • Fax: 303-678-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number800000019
License Number StateCO

VIII. Authorized Official

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