Organization
OPTUMCARE COLORADO SPRINGS, LLC
Active
Other names
DaVita Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
5115 FONTAINE BLVD, FOUNTAIN, CO 80817-1061
(719) 392-2000
(719) 392-6937
Mailing address
2 S CASCADE AVE, STE 140, COLORADO SPRINGS, CO 80903-1624
(719) 538-2900
(719) 538-2987
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
12/02/2016
Last updated
08/20/2019
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