Provider Demographics
NPI:1750055976
Name:ROCKY MOUNTAIN CANCER CENTERS LLP
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN CANCER CENTERS LLP
Other - Org Name:ROCKY MOUNTAIN CANCER CENTERS-LONGMONT-MOBILE PETCT
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WORTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-930-7803
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4758
Mailing Address - Country:US
Mailing Address - Phone:303-930-7803
Mailing Address - Fax:303-930-5503
Practice Address - Street 1:1380 TULIP ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3157
Practice Address - Country:US
Practice Address - Phone:303-930-7800
Practice Address - Fax:303-930-5503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN CANCER CENTERS LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-02
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty