=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770911729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAISER FOUNDATION HEALTH PLAN OF COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2013
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10240 PARK MEADOW DR
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-649-5550
-----------------------------------------------------
Fax | 303-649-5565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10240 PARK MEADOWS DR
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-649-5550
-----------------------------------------------------
Fax | 303-649-5565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AREAS ADMINISTRATOR, PHARMACY
-----------------------------------------------------
Name | DENESE CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-326-6717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336M0003X
-----------------------------------------------------
Taxonomy Name | Managed Care Organization Pharmacy
-----------------------------------------------------
License Number | 1680000044
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------