Provider Demographics
NPI:1235581042
Name:MOUNTAIN SUMMIT DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MOUNTAIN SUMMIT DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:NYCOL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-924-5768
Mailing Address - Street 1:10 BURNETT CT
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 BURNETT CT
Practice Address - Street 2:SUITE 325
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3611
Practice Address - Country:US
Practice Address - Phone:972-924-5768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory