Provider Demographics
NPI:1659974897
Name:ROCKY MOUNTAIN CANCER CENTERS, LLP
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN CANCER CENTERS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:FROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-930-7895
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4726
Mailing Address - Country:US
Mailing Address - Phone:303-930-7895
Mailing Address - Fax:303-267-4477
Practice Address - Street 1:3676 PARKER BLVD STE 350
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2213
Practice Address - Country:US
Practice Address - Phone:719-296-6000
Practice Address - Fax:719-545-1146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN CANCER CENTERS, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty