Healthcare Provider Details

I. General information

NPI: 1386350924
Provider Name (Legal Business Name): ROCKY MOUNTAIN CANCER CENTERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE STE 400
COLORADO SPRINGS CO
80907-5320
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-667-6980
  • Fax: 719-667-6998
Mailing address:
  • Phone: 303-930-7803
  • Fax: 303-930-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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