Provider Demographics
NPI:1114327749
Name:CENTURY RADIATION ONCOLOGY COLORADO PLLC
Entity Type:Organization
Organization Name:CENTURY RADIATION ONCOLOGY COLORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-589-6879
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-589-6879
Mailing Address - Fax:713-863-8308
Practice Address - Street 1:5275 DTC PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2772
Practice Address - Country:US
Practice Address - Phone:720-214-6700
Practice Address - Fax:303-770-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherEIN