Basic Information
| Provider Information | |||||||||
| NPI: | 1285242636 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN CANCER CENTERS LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7951 E MAPLEWOOD AVE STE 300 | ||||||||
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| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039307895 | ||||||||
| FaxNumber: | 3032674477 | ||||||||
| Practice Location | |||||||||
| Address1: | 10107 RIDGEGATE PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039250700 | ||||||||
| FaxNumber: | 3033292599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2020 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | JESSE | ||||||||
| AuthorizedOfficialFirstName: | FROYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3039307895 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 29480531 | 05 | CO | MEDICAID |