Optumcare Colorado Medical Group Llc | |
1106 N Cascade Ave Colorado Springs CO 80903-1355 | |
(719) 389-6384 | |
Not Available |
Full Name | Optumcare Colorado Medical Group Llc |
---|---|
Speciality | Non-pharmacy Dispensing Site |
Location | 1106 N Cascade Ave, Colorado Springs, Colorado |
Authorized Official Name and Position | Emily Castillo (ASSOCIATE DIRECTOR CREDENTIALING) |
Authorized Official Contact | 7025793253 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Optumcare Colorado Medical Group Llc Po Box 35380 Las Vegas NV 89133-5380 Ph: (702) 579-3203 | Optumcare Colorado Medical Group Llc 1106 N Cascade Ave Colorado Springs CO 80903-1355 Ph: (719) 389-6384 |
NPI Number | 1952652422 |
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Provider Enumeration Date | 09/25/2012 |
Last Update Date | 08/20/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952652422 | NPI | - | NPPES |
04740080 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
332900000X | Non-pharmacy Dispensing Site | (* (Not Available)) | Primary |
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