MEDICARE: ROCKY MOUNTAIN CANCER CENTERS, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1992308118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN CANCER CENTERS, LLP

Provider Business Mailing Address
First Line	:	7951 E MAPLEWOOD AVE STE 350
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4758
Country	:	US
Telephone Number	:	303-930-7895
Fax Number	:	303-267-4477

Provider Business Practice Location Address
First Line	:	11750 W 2ND PL STE 160
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1724
Country	:	US
Telephone Number	:	303-430-2700
Fax Number	:	303-430-2770

Authorized Official
Title or Position	:	SENIOR CREDENTIALING COORDINATOR
Name	:	NANCY WORTHAM
Credential	:
Telephone Number	:	303-930-7803

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	07/15/2021

Similar Medicare Providers

1912650078 — MS. JULIE ANN HINCHMAN ACNP
Practice Location Address:

11750 W 2ND PL STE 160
LAKEWOOD, CO
80228-1724

Practice Phone: 303-430-2700
Practice Fax: 303-430-2770

1629016100 — ELIZABETH ANN CEILLEY M.D.
Practice Location Address:

11750 W 2ND PL STE 150
LAKEWOOD, CO
80228-1724

Practice Phone: 720-321-8800
Practice Fax: 720-321-8801

1003166109 — DR. JEFFREY MARTIN ALBERT M.D.
Practice Location Address:

11750 W 2ND PL STE 150
LAKEWOOD, CO
80228-1724

Practice Phone: 720-321-8800
Practice Fax: 720-321-8801

1568995223 — DR. VISHAL RAMESH DHERE M.D.
Practice Location Address:

11750 W 2ND PL STE 150
LAKEWOOD, CO
80228-1724

Practice Phone: 720-321-8800
Practice Fax: 720-321-8801

1740791623 — KELLY GAYDOSH PA-C
Practice Location Address:

11750 W 2ND PL STE 160
LAKEWOOD, CO
80228-1724

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1396303954 — LAUREN ROBIN BLISS PA-C
Practice Location Address:

11750 W 2ND PL STE 160
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80228-1724

Practice Phone: 303-403-2700
Practice Fax: 303-430-2770

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