1114439924 NPI number — CANCER CENTERS OF COLORADO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114439924 NPI number — CANCER CENTERS OF COLORADO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CENTERS OF 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:
6
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:
1114439924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ELDORADO BLVD STE 4300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-3564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 LOWELL BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80204-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-403-6820
Provider Business Practice Location Address Fax Number:
303-403-6393
Provider Enumeration Date:
11/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK-ANDERSEN
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR CANCER SERVICE LINE AND SP
Authorized Official Telephone Number:
303-425-8145

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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