Provider Demographics
NPI:1568093847
Name:OPTUMCARE COLORADO MEDICAL GROUP LLC
Entity type:Organization
Organization Name:OPTUMCARE COLORADO MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-579-3253
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:3470 CENTENNIAL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8669
Practice Address - Country:US
Practice Address - Phone:719-598-4588
Practice Address - Fax:719-594-4067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUMCARE COLORADO MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-27
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty