Provider Demographics
NPI:1457723553
Name:DENVER REGIONAL ONCOLOGY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:DENVER REGIONAL ONCOLOGY MEDICAL GROUP, LLC
Other - Org Name:ADVANCED CANCER CARE OF COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:949-385-5012
Mailing Address - Street 1:28812 WEYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6747
Mailing Address - Country:US
Mailing Address - Phone:216-265-4580
Mailing Address - Fax:
Practice Address - Street 1:5275 DTC PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2772
Practice Address - Country:US
Practice Address - Phone:720-214-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty