Provider Demographics
NPI:1679589477
Name:MOUNTAIN RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:MOUNTAIN RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHEWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-332-6346
Mailing Address - Street 1:4704 HARLAN STREET
Mailing Address - Street 2:SUITE 511
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7427
Mailing Address - Country:US
Mailing Address - Phone:720-382-1008
Mailing Address - Fax:720-382-1012
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-332-6346
Practice Address - Fax:303-425-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60550830Medicaid
CO60550830Medicaid