Healthcare Provider Details

I. General information

NPI: 1255949608
Provider Name (Legal Business Name): ROCKY MOUNTAIN CANCER CENTERS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N WILLIAMS ST STE 100
DENVER CO
80218-1237
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 300
GREENWOOD VILLAGE CO
80111-4726
US

V. Phone/Fax

Practice location:
  • Phone: 303-285-5020
  • Fax: 303-285-5097
Mailing address:
  • Phone: 303-930-7895
  • Fax: 303-267-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FROYA JESSE
Title or Position: SENIOR CREDENTIALING COORDINATOR
Credential:
Phone: 303-930-7895