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Organization

MOUNTAIN BLUE CANCER CARE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SAMIR WITTA (PRACTICE MANAGER)
(303) 870-3293
Entity
Organization

Contact information

Practice address
3501 S CORONA ST STE 1, ENGLEWOOD, CO 80113-3907
(303) 999-6745
(303) 586-2228
Mailing address
4747 S DOWNING ST, ENGLEWOOD, CO 80113-5917
(303) 999-6745
(303) 586-2228

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
82076529
CO
Enumeration date
01/04/2022
Last updated
05/09/2024
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