Healthcare Provider Details

I. General information

NPI: 1821448689
Provider Name (Legal Business Name): CENTURY CANCER CENTERS COLORADO SPRINGS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 MEDICAL CENTER PT #100
COLORADO SPRINGS CO
80907-5764
US

IV. Provider business mailing address

2865 E COAST HWY SUITE 210
CORONA DEL MAR CA
92625-2236
US

V. Phone/Fax

Practice location:
  • Phone: 719-247-5500
  • Fax: 719-247-5437
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SANJAY MEHTA
Title or Position: OWNER
Credential: MD
Phone: 713-589-6879