Basic Information
| Provider Information | |||||||||
| NPI: | 1932704905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARECONNECTMD COLORADO INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3090 BRISTOL ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926263061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887899585 | ||||||||
| FaxNumber: | 5628034500 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 BROADWAY STE 1600 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802024916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572025944 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2020 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | FIELDS | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7145524123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.