Healthcare Provider Details

I. General information

NPI: 1568056729
Provider Name (Legal Business Name): NATIONAL JEWISH NORTHERN HEMOTOLOGY ONCOLOGY (PHYSICIAN CLAIMS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9451 HURON ST
THORNTON CO
80260-5426
US

IV. Provider business mailing address

1400 JACKSON ST
DENVER CO
80206-2761
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4042
  • Fax: 303-650-4046
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-398-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. VICKI MEDINA
Title or Position: MEDICAL STAFF SERIVCES
Credential: DIRECTOR
Phone: 303-388-4461