Provider Demographics
NPI:1801576871
Name:PROSTATE CANCER INSTITUTE OF COLORADO PC
Entity type:Organization
Organization Name:PROSTATE CANCER INSTITUTE OF COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATNAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-360-4009
Mailing Address - Street 1:1445 W CHANDLER BLVD STE A5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6130
Mailing Address - Country:US
Mailing Address - Phone:480-360-4009
Mailing Address - Fax:480-360-4124
Practice Address - Street 1:7535 E HAMPDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4844
Practice Address - Country:US
Practice Address - Phone:303-276-4146
Practice Address - Fax:303-276-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty