Provider Demographics
NPI:1205359155
Name:DAVITA MEDICAL GROUP COLORADO SPRINGS, LLC
Entity Type:Organization
Organization Name:DAVITA MEDICAL GROUP COLORADO SPRINGS, LLC
Other - Org Name:DAVITA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-876-6457
Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-866-6571
Mailing Address - Fax:
Practice Address - Street 1:1633 MEDICAL CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5700
Practice Address - Country:US
Practice Address - Phone:719-636-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVITA MEDICAL GROUP COLORADO SPRINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies