Provider Demographics
NPI:1942278361
Name:CENTENNIAL RADIATION ONCOLOGY, P.C.
Entity Type:Organization
Organization Name:CENTENNIAL RADIATION ONCOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-926-9800
Mailing Address - Street 1:120 OLD LARAMIE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7012
Mailing Address - Country:US
Mailing Address - Phone:303-926-9800
Mailing Address - Fax:303-926-9801
Practice Address - Street 1:120 OLD LARAMIE TRL E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7012
Practice Address - Country:US
Practice Address - Phone:303-926-9800
Practice Address - Fax:303-926-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019378Medicaid
COCA3808Medicare ID - Type Unspecified
CO04019378Medicaid