1073361440 NPI number — CAST COLORADO, LLC.

Table of content: (NPI 1073361440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073361440 NPI number — CAST COLORADO, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAST COLORADO, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073361440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-3555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-206-4673
Provider Business Mailing Address Fax Number:
719-435-4228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 SPRUCE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JARA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-206-4673
Provider Business Practice Location Address Fax Number:
719-435-4228
Provider Enumeration Date:
05/09/2024

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-FOUNDER. CEO. VICE-CHAIRMAN, & O
Authorized Official Telephone Number:
720-833-8453

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000231317 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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