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General NPI Number Information
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NPI Number | 1659641900
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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 | 01/04/2012
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1633 MEDICAL CENTER PT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5700
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Country | US
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Telephone | 719-636-2999
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Fax | 719-475-2042
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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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 |
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Taxonomy #8
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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