1952373953 NPI number — COLORADO PATHOLOGY CONSULTANTS PC

Table of content: (NPI 1952373953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952373953 NPI number — COLORADO PATHOLOGY CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO PATHOLOGY CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952373953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-8018
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
695 S BROADWAY
Provider Second Line Business Practice Location Address:
SUITE100
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-899-6900
Provider Business Practice Location Address Fax Number:
303-899-6999
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
702-733-7866

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  06D0511305 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08003212 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: COM5008 . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1952373953 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001272 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86420038 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200381880A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70860100 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952373953 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952373953 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1952373953 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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