Provider Demographics
NPI:1114439924
Name:CANCER CENTERS OF COLORADO, LLC
Entity Type:Organization
Organization Name:CANCER CENTERS OF COLORADO, LLC
Other - Org Name:CCC SLOAN'S LAKE INFUSION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CANCER SERVICE LINE AND SP
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK-ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-425-8145
Mailing Address - Street 1:500 ELDORADO BLVD STE 4300
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 LOWELL BLVD STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1545
Practice Address - Country:US
Practice Address - Phone:303-403-6820
Practice Address - Fax:303-403-6393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty