Provider Demographics
NPI:1245784248
Name:INNOVATIVE CANCER CARE, PLLC
Entity Type:Organization
Organization Name:INNOVATIVE CANCER CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-570-2760
Mailing Address - Street 1:4704 HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7415
Mailing Address - Country:US
Mailing Address - Phone:720-382-1008
Mailing Address - Fax:720-382-1012
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:303-570-2760
Practice Address - Fax:303-770-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO398302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86231774Medicaid