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NPI Code Detail

MEDICARE: OPTUMCARE COLORADO MEDICAL GROUP LLC

MEDICARE: OPTUMCARE COLORADO MEDICAL GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1164289732
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTUMCARE COLORADO MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 2 S CASCADE AVE STE 140
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1604
Country : US
Telephone Number : 719-538-2900
Fax Number : 719-538-2990
Provider Business Practice Location Address
First Line : 110 N RUBEY DR UNIT 200
Second Line :
City : GOLDEN
State : CO
Zip : 80403-3201
Country : US
Telephone Number : 303-376-0975
Fax Number : 303-731-3500
Authorized Official
Title or Position : REGIONAL MEDICAL STAFF MANAGER
Name : EMILY CASTILLO
Credential :
Telephone Number : 702-579-3253
Provider Enumeration Date : 02/29/2024
Last Update Date : 02/29/2024

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Directions to “OPTUMCARE COLORADO MEDICAL GROUP LLC ” Practice Location

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