1205439452 NPI number — ROCKY MOUNTAIN CANCER CENTERS, LLP

Table of content: (NPI 1205439452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205439452 NPI number — ROCKY MOUNTAIN CANCER CENTERS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN CANCER CENTERS, LLP
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:
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NPI Number Information

NPI Number:
1205439452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7951 E MAPLEWOOD AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-4726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-930-7895
Provider Business Mailing Address Fax Number:
303-267-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9397 CROWN CREST BLVD STE 421
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-8789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-805-7744
Provider Business Practice Location Address Fax Number:
720-851-4141
Provider Enumeration Date:
11/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
JESSE
Authorized Official First Name:
FROYA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
303-930-7895

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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