Healthcare Provider Details

I. General information

NPI: 1649670282
Provider Name (Legal Business Name): CENTURY RADIATION ONCOLOGY COLORADO SPRINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 MEDICAL CENTER PT SUITE 100
COLORADO SPRINGS CO
80907-5760
US

IV. Provider business mailing address

6565 WEST LOOP S SUITE 400
BELLAIRE TX
77401-3500
US

V. Phone/Fax

Practice location:
  • Phone: 719-247-5500
  • Fax: 719-247-5437
Mailing address:
  • Phone: 713-589-6879
  • Fax: 713-863-8308

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: SANJAY MEHTA
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 713-589-6879