Provider Demographics
NPI:1235289554
Name:COLORADO CANCER CARE LLC
Entity Type:Organization
Organization Name:COLORADO CANCER CARE LLC
Other - Org Name:COLORADO BLOOD & CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-346-7777
Mailing Address - Street 1:3601 S CLARKSON ST STE 520
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3949
Mailing Address - Country:US
Mailing Address - Phone:303-346-7777
Mailing Address - Fax:303-346-7778
Practice Address - Street 1:3601 S CLARKSON ST STE 520
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3949
Practice Address - Country:US
Practice Address - Phone:303-346-7777
Practice Address - Fax:303-346-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23836207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0123869Medicaid
WY105350700Medicaid
CO65551346Medicaid
COC807903Medicare PIN
WY105350700Medicaid
COCO304984Medicare PIN