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 |