1508464850 NPI number — CARDINAL PATHOLOGY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508464850 NPI number — CARDINAL PATHOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDINAL PATHOLOGY, 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:
1508464850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX #2725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-945-7564
Provider Business Mailing Address Fax Number:
970-945-0563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W. MEADOW DRIVE
Provider Second Line Business Practice Location Address:
VAIL HEALTH
Provider Business Practice Location Address City Name:
VAIL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-7564
Provider Business Practice Location Address Fax Number:
970-945-0563
Provider Enumeration Date:
10/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MACAULAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-945-7564

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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