Active NPI
Mountain Blue Cancer Care Center
- Hematology & Oncology Physician
- Englewood, CO
National Provider Identifier
1013678879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- Legal business name
- MOUNTAIN BLUE CANCER CARE CENTER
- Practice address
- 3501 S Corona St Ste 1
Englewood, CO 80113-3907 - Phone
- (303) 999-6745
- Fax
- (303) 586-2228
- NPI assigned
- Jan 4, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samir Witta
- Title
- Practice Manager
- Phone
- (303) 870-3293
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | Primary |
Addresses
Primary practice location
3501 S Corona St Ste 1
Englewood, CO 80113-3907
Mailing address
4747 S Downing St
Englewood, CO 80113-5917
Phone (303) 999-6745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82076529 | Medicaid | CO |
National Provider Directory
National Provider Directory- Tax ID family
- Mountain Blue Cancer Care Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Hematology & Oncology Physician
- Aurora, CO
- NPI 1043971807
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Hematology & Oncology Physician
- Englewood, CO
- NPI 1013991678
Hematology & Oncology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641254400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715212800000",
"number": "1013678879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4747 S DOWNING ST",
"city": "ENGLEWOOD",
"state": "CO",
"postal_code": "801135917",
"telephone_number": "303-999-6745",
"fax_number": "303-586-2228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 S CORONA ST STE 1",
"city": "ENGLEWOOD",
"state": "CO",
"postal_code": "801133907",
"telephone_number": "303-999-6745",
"fax_number": "303-586-2228"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOUNTAIN BLUE CANCER CARE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2022-01-04",
"last_updated": "2024-05-09",
"certification_date": "2024-05-09",
"status": "A",
"authorized_official_last_name": "WITTA",
"authorized_official_first_name": "SAMIR",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "303-870-3293"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Hematology & Oncology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "82076529",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Englewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.