Mountain Blue Cancer Care Center PC

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

Legal business name

MOUNTAIN BLUE CANCER CARE CENTER PC

Practice address

1444 S Potomac St Ste 190
Aurora, CO 80012-4523

Phone

(303) 788-8675

Fax

(303) 788-8489

NPI assigned

Jan 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Heather Donnahoo

Title

Practice Administrator

Phone

(303) 731-9495

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mountain Blue Cancer Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mountain Blue Cancer Care Center

  • Hematology & Oncology Physician
  • Englewood, CO
  • NPI 1013678879
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samir Ezzeldin Witta, MD PHD

  • Hematology & Oncology Physician
  • Englewood, CO
  • NPI 1013991678

  Hematology & Oncology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1043971807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "799 E HAMPDEN AVE STE 500",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801132777",
            "telephone_number": "303-788-8675",
            "fax_number": "303-788-8489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 S POTOMAC ST STE 190",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124523",
            "telephone_number": "303-788-8675",
            "fax_number": "303-788-8489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN BLUE CANCER CARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "DONNAHOO",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "303-731-9495"
    },
    "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": []
}

• Carl Nee-Kofi Mould-Millman, MD
• Karen Moulton, MD
• Steven L Moulton, MD
• Sarah Moultrie, CPNP-AC
• Irvin Moultry, RDN
• Mountain View Eyecare LLC
• Mountain View Pain Center
• Benjamin Maresh Mountjoy
• Kimberly Ann Mourani, MD
• Ghizlane Moussarrif

• All providers in Aurora, CO
• Hematology & Oncology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.