Provider Demographics
NPI:1659641900
Name:OPTUMCARE COLORADO SPRINGS, LLC
Entity Type:Organization
Organization Name:OPTUMCARE COLORADO SPRINGS, LLC
Other - Org Name:COLORADO SPRINGS HEALTH PARTNERS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIETHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-205-6262
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:719-636-2999
Mailing Address - Fax:719-475-2042
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:SUITE 122
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-636-2999
Practice Address - Fax:719-475-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site