Provider Demographics
NPI:1306826482
Name:PIKES PEAK RADIATION ONCOLOGY P.C.
Entity Type:Organization
Organization Name:PIKES PEAK RADIATION ONCOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAZUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-570-7675
Mailing Address - Street 1:1425 N UNION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2871
Mailing Address - Country:US
Mailing Address - Phone:719-570-7675
Mailing Address - Fax:719-471-9314
Practice Address - Street 1:1425 N UNION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2871
Practice Address - Country:US
Practice Address - Phone:719-570-7675
Practice Address - Fax:719-471-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017968Medicaid
CO40421OtherBCBS
CO04017968Medicaid