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General NPI Number Information
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NPI Number | 1245781723
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Entity Type | Organization
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Legal Business Name | OPTUMCARE COLORADO MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 6025 DELMONICO DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2251
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Country | US
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Telephone | 719-535-0648
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Fax | 719-262-5574
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Provider Business Mailing Address
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Address Line | 6025 DELMONICO DRIVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-2251
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Country | US
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Telephone | 719-538-2900
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Fax | 719-538-2987
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR CREDENTIALING
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-579-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | CO
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