Basic Information
Provider Information
NPI: 1407479975
EntityType: 2
ReplacementNPI:  
OrganizationName: UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: UCHEALTH CCMC RADIATION ONCOLOGY OP
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 7901 E LOWRY BLVD, F402, 3RD FLOOR
Address2:  
City: DENVER
State: CO
PostalCode: 80230
CountryCode: US
TelephoneNumber: 7205531754
FaxNumber:  
Practice Location
Address1: 100 COOK ST STE 102
Address2:  
City: DENVER
State: CO
PostalCode: 802065327
CountryCode: US
TelephoneNumber: 7208480000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2020
LastUpdateDate: 09/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ALFORD
AuthorizedOfficialFirstName: JON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO, UCHEALTH METRO DENVER REGION
AuthorizedOfficialTelephone: 7208487773
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X  N Ambulatory Health Care FacilitiesClinic/Center 
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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