# OPTUMCARE COLORADO MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OPTUMCARE COLORADO MEDICAL GROUP LLC
- **Other names:** Optumcare Colorado Springs LLC, MDVIP DR THEODORE LAWSON
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902437874
- **Legal business name:** OPTUMCARE COLORADO MEDICAL GROUP LLC
- **Authorized official:** EMILY CASTILLO (ASSOCIATE DIRECTOR CREDENTIALING)
- **Authorized official phone:** (702) 579-3253

## Contact information

- **Practice address:** 3470 CENTENNIAL BLVD STE 210, COLORADO SPRINGS, CO 80907-8669
- **Practice address phone:** (719) 463-5600
- **Practice address fax:** (719) 538-2990
- **Mailing address:** PO BOX 35380, LAS VEGAS, NV 89133-5380
- **Mailing address phone:** (702) 579-3203
- **Mailing address fax:** (719) 538-2990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/30/2020
- **Last updated:** 08/20/2024