Provider Demographics
NPI:1407805351
Name:FRONT RANGE CANCER SPECIALISTS PC
Entity Type:Organization
Organization Name:FRONT RANGE CANCER SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS (GYULA)
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDGYESY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-212-7600
Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:#110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-212-7600
Mailing Address - Fax:970-212-7637
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:#110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-212-7600
Practice Address - Fax:970-212-7637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83679561Medicaid
CO3003OtherNEIC SITE ID, NSF BA0-7
COC801223OtherMEDICARE PTAN
COFRF64319OtherBLUE CROSS BLUE SHIELD ID
CODD0348OtherMEDICARE RAILROAD