Healthcare Provider Details

I. General information

NPI: 1740751049
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W PUEBLO BLVD
PUEBLO CO
81004
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S RAMSEIER JR.
Title or Position: REGIONAL PRESIDENT
Credential:
Phone: 303-344-7256