Provider Demographics
NPI:1073694782
Name:SUMMIT RADIATION ONCOLOGY,P.C.
Entity Type:Organization
Organization Name:SUMMIT RADIATION ONCOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATESKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-629-3610
Mailing Address - Street 1:8300 W. 38TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-0000
Mailing Address - Country:US
Mailing Address - Phone:303-629-3610
Mailing Address - Fax:303-595-6806
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-629-3610
Practice Address - Fax:303-595-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01274224Medicaid
CO01274224Medicaid
COE91941Medicare UPIN