Provider Demographics
NPI:1487989935
Name:OPTIMUM HEALTH CENTER, LLC
Entity type:Organization
Organization Name:OPTIMUM HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-635-2500
Mailing Address - Street 1:1809 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2410
Mailing Address - Country:US
Mailing Address - Phone:719-635-2500
Mailing Address - Fax:719-635-2500
Practice Address - Street 1:1809 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2410
Practice Address - Country:US
Practice Address - Phone:719-635-2500
Practice Address - Fax:719-635-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2425261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)