Provider Demographics
NPI:1528233905
Name:VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:VALLEY RADIOTHERAPY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELIOTT
Authorized Official - Last Name:BOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-335-4056
Mailing Address - Street 1:4704 HARLAN STREET
Mailing Address - Street 2:SUITE 511
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7427
Mailing Address - Country:US
Mailing Address - Phone:720-382-1008
Mailing Address - Fax:720-382-1012
Practice Address - Street 1:799 E. HAMPDEN AVENUE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-788-5860
Practice Address - Fax:303-788-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ9454OtherRR MEDICARE
CO652073OtherBCBS OF CO
CO92775721Medicaid
CO08307229Medicaid
CO08307229Medicaid
CO652073OtherBCBS OF CO