NPI | 1568093847 |
---|---|
Former Legal Business Name | DAVITA MEDICAL GROUP COLORADO SPRINGS LLC |
Doing Business As | MOUNTAINVIEW MEDICAL GROUP AT CENTENIAL |
Former Legal Business Name | OPTUMCARE COLORADO SPRINGS LLC |
Entity Type | Organization |
Authorized Contact | EMILY CASTILLO Associate Director Credentialing 702-579-3253 |
Organization Subpart ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine |
Enumeration Date | 2020-01-27 |
Last Update Date | 2024-08-20 |