| Davita Medical Group | |
|
5115 Fontaine Blvd Fountain CO 80817-1061 | |
| (719) 392-2000 | |
| (719) 392-6937 |
| Full Name | Davita Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 5115 Fontaine Blvd, Fountain, Colorado |
| Authorized Official Name and Position | John G. Liethen (SECRETARY) |
| Authorized Official Contact | 9522056262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Davita Medical Group 2 S Cascade Ave Ste 140 Colorado Springs CO 80903-1624 Ph: (719) 538-2900 | Davita Medical Group 5115 Fontaine Blvd Fountain CO 80817-1061 Ph: (719) 392-2000 |
| NPI Number | 1316480783 |
|---|---|
| Provider Enumeration Date | 12/02/2016 |
| Last Update Date | 08/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316480783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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