Healthcare Provider Details

I. General information

NPI: 1962150243
Provider Name (Legal Business Name): ROCKY MOUNTAIN CANCER CENTERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6031 E WOODMEN RD STE 200
COLORADO SPRINGS CO
80923-2625
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 350
GREENWOOD VILLAGE CO
80111-4758
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-2555
  • Fax: 719-577-2553
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY R. WORTHAM
Title or Position: SENIOR CREDENTIALING COORDINATOR
Credential:
Phone: 303-930-7803