Healthcare Provider Details

I. General information

NPI: 1568636637
Provider Name (Legal Business Name): FOOTHILLS HEMATOLOGY ONCOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E HAMPDEN AVE SUITE 500
ENGLEWOOD CO
80113-2700
US

IV. Provider business mailing address

799 E HAMPDEN AVE SUITE 500
ENGLEWOOD CO
80113-2700
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8675
  • Fax:
Mailing address:
  • Phone: 303-788-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number42668
License Number StateCO

VIII. Authorized Official

Name: DR. EDGAR F PRASTHOFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-788-8675