Basic Information
| Provider Information | |||||||||
| NPI: | 1952373953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO PATHOLOGY CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149328018 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 695 S BROADWAY | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802094003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038996900 | ||||||||
| FaxNumber: | 3038996999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOLAN | ||||||||
| AuthorizedOfficialFirstName: | KRISTIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9737234736 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERIPATH INC. | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 06D0511305 | CO | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 70860100 | 05 | MO | MEDICAID | 1952373953 | 05 | ID | MEDICAID | 86420038 | 05 | NM | MEDICAID | COM5008 | 01 | CO | BCBS | OTHER | 1952373953 | 05 | WY | MEDICAID | 1952373953 | 05 | MT | MEDICAID | 7001272 | 05 | NC | MEDICAID | 1952373953 | 05 | UT | MEDICAID | 200381880A | 05 | KS | MEDICAID | 08003212 | 05 | CO | MEDICAID |