Provider Demographics
NPI:1528190295
Name:OPTUMCARE COLORADO MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:OPTUMCARE COLORADO MEDICAL GROUP LLC
Other - Org Name:OPTUMCARE COLORADO SPRINGS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-2550
Mailing Address - Street 1:2 S CASCADE AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1653
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:719-538-2961
Practice Address - Street 1:1615 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1906
Practice Address - Country:US
Practice Address - Phone:719-636-3555
Practice Address - Fax:719-667-4222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUMCARE COLORADO MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA61003Medicare PIN