06D0922448 CLIA NUMBER - OPTUM

Laboratory Demographics

CLIA Number: 06D0922448

Facility Name: OPTUM

Facility Address:
5115 FONTAINE BLVD
FOUNTAIN, CO
ZIP 80817
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Facility Phone Number: 719 522-1133

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316480783

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	06D0922448
LAB Type	Physician Office
Facility Name	OPTUM
Street	5115 FONTAINE BLVD
City	FOUNTAIN
State	CO
ZIP	80817
Phone	719 522-1133
CertificateType	4
CertificateEffectiveDate	4/19/2023
CertificateExpirationDate	4/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024