Provider Demographics
NPI:1790818425
Name:WESTERN HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WESTERN HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-986-9504
Mailing Address - Street 1:32 VAN GORDON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:303-986-9504
Mailing Address - Fax:303-716-0239
Practice Address - Street 1:34 VAN GORDON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1705
Practice Address - Country:US
Practice Address - Phone:303-986-9504
Practice Address - Fax:303-716-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007696Medicaid
COD5108Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER