| NPI | 1225669518 |
|---|---|
| Former Legal Business Name | MOUNTAIN VIEW MEDICAL GROUP |
| Former Legal Business Name | DAVITA MEDICAL GROUP COLORADO SPRINGS, LLC |
| Doing Business As | OPTUM COLORADO SPRINGS - MVMG PEDIATRIC SPECIALIST |
| Entity Type | Organization |
| Authorized Contact | EMILY CASTILLO Associate Director Credentialing 702-579-3253 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2024-08-20 |