Provider Demographics
NPI:1770658353
Name:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Other - Org Name:KAISER PERMANENTE CENTER POINT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENESE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-326-6717
Mailing Address - Street 1:14701 E EXPOSITION AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2623
Mailing Address - Country:US
Mailing Address - Phone:303-614-7300
Mailing Address - Fax:303-614-7303
Practice Address - Street 1:14701 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2623
Practice Address - Country:US
Practice Address - Phone:303-614-7300
Practice Address - Fax:303-614-7303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CO700000073336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003192OtherPK