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General NPI Number Information
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NPI Number | 1992562441
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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 | 03/01/2024
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 1707 COLE BLVD STE 100
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City | GOLDEN
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State | CO
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Zip | 80401-3219
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Country | US
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Telephone | 303-763-4900
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Fax |
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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 | 702-480-2550
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Fax |
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Authorized Official
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Title or Position | REGIONAL MEDICAL STAFF MANAGER
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-480-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology 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 | 2084P0800X
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Taxonomy Name | Psychiatry 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 | 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 #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism 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 | 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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