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MOUNTAIN BLUE CANCER CARE CENTER PC NPI 1013678879


NPI Information

NPI: 1013678879
Provider Name: MOUNTAIN BLUE CANCER CARE CENTER PC
Classification: Internal Medicine - 207RH0003X
Entity Type: Organization

Specialization: Hematology & Oncology

Address:
3501 S CORONA ST STE 1
ENGLEWOOD, CO
ZIP 80113
Phone: (303) 999-6745
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MOUNTAIN BLUE CANCER CARE CENTER PC is a hematology and oncology internal medicine in Englewood, CO. The provider is an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. MOUNTAIN BLUE CANCER CARE CENTER PC NPI is 1013678879. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3501 S CORONA ST STE 1
ENGLEWOOD, CO
ZIP 80113-907
Phone: (303) 999-6745
Fax: (303) 586-2228

The provider's authorized official is Samir Witta .
The authorized official title is Practice Manager and has the following contact phone number (303) 870-3293.

The enumeration date for this NPI number is 1/4/2022 and was last updated on 1/6/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RH0003XInternal MedicineHematology & OncologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
182076529MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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