Provider Demographics
NPI:1154563807
Name:BOULDER CANCER CENTER, LLC
Entity type:Organization
Organization Name:BOULDER CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAWERANCE
Authorized Official - Last Name:SCHEWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-448-4620
Mailing Address - Street 1:905 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3305
Mailing Address - Country:US
Mailing Address - Phone:303-448-4620
Mailing Address - Fax:303-449-5807
Practice Address - Street 1:905 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3305
Practice Address - Country:US
Practice Address - Phone:303-448-4620
Practice Address - Fax:303-449-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2009469012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty