Healthcare Provider Details

I. General information

NPI: 1043971807
Provider Name (Legal Business Name): MOUNTAIN BLUE CANCER CARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S POTOMAC ST STE 190
AURORA CO
80012-4523
US

IV. Provider business mailing address

799 E HAMPDEN AVE STE 500
ENGLEWOOD CO
80113-2777
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8675
  • Fax: 303-788-8489
Mailing address:
  • Phone: 303-788-8675
  • Fax: 303-788-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DONNAHOO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-731-9495