Provider Demographics
NPI:1164020715
Name:SUMMIT PATHOLOGY
Entity Type:Organization
Organization Name:SUMMIT PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-212-0557
Mailing Address - Street 1:PO BOX 913258
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3258
Mailing Address - Country:US
Mailing Address - Phone:970-212-0530
Mailing Address - Fax:
Practice Address - Street 1:2301 HOUSE AVE STE 108
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3177
Practice Address - Country:US
Practice Address - Phone:307-274-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty