Basic Information
| Provider Information | |||||||||
| NPI: | 1164020715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 913258 | ||||||||
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| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802913258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702120530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 HOUSE AVE STE 108 | ||||||||
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| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072743057 | ||||||||
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| ProviderEnumerationDate: | 10/15/2020 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTINSON | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9702120557 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZH0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.