1821448689 NPI number — CENTURY CANCER CENTERS COLORADO SPRINGS, PLLC

Table of content: (NPI 1821448689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821448689 NPI number — CENTURY CANCER CENTERS COLORADO SPRINGS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURY CANCER CENTERS COLORADO SPRINGS, PLLC
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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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1821448689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 E COAST HWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
CORONA DEL MAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92625-2236
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:
1644 MEDICAL CENTER PT
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-5764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-247-5500
Provider Business Practice Location Address Fax Number:
719-247-5437
Provider Enumeration Date:
06/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MEHTA
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-589-6879

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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