Healthcare Provider Details

I. General information

NPI: 1003046905
Provider Name (Legal Business Name): COLORADO CYBERKNIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OLD LARAMIE TRL E
LAFAYETTE CO
80026-7012
US

IV. Provider business mailing address

120 OLD LARAMIE TRL E
LAFAYETTE CO
80026-7012
US

V. Phone/Fax

Practice location:
  • Phone: 303-926-9800
  • Fax: 303-926-9801
Mailing address:
  • Phone: 303-926-9800
  • Fax: 303-926-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES KELLEY SIMPSON
Title or Position: OWNER
Credential: M.D.
Phone: 303-926-9800