Organization
CREEKSIDE CANCER CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES KELLEY SIMPSON M.D. (MEDICAL DIRECTOR)
(303) 926-9800
Entity
Organization
Contact information
Practice address
120 OLD LARAMIE TRL E, LAFAYETTE, CO 80026-7012
(303) 926-9800
(303) 926-9801
Mailing address
120 OLD LARAMIE TRL E, LAFAYETTE, CO 80026-7012
(303) 926-9800
(303) 926-9801
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COB4795
MEDICARE INDIVIDUAL AND GROUP PTAN
CO
Enumeration date
07/27/2009
Last updated
10/18/2010
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