MEDICARE: ROCKY MOUNTAIN CANCER CENTERS, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1720681968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN CANCER CENTERS, LLP

Provider Business Mailing Address
First Line	:	7951 E MAPLEWOOD AVE STE 350
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4758
Country	:	US
Telephone Number	:	303-930-7803
Fax Number	:	303-930-5503

Provider Business Practice Location Address
First Line	:	525 W 15TH ST STE 200
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2716
Country	:	US
Telephone Number	:	719-296-6000
Fax Number	:	719-545-1146

Authorized Official
Title or Position	:	SENIOR CREDENTIALING COORDINATOR
Name	:	NANCY R. WORTHAM
Credential	:
Telephone Number	:	303-930-7803

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	09/21/2023

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