Provider Demographics
NPI:1235621285
Name:SOUTHERN COLORADO PATHOLOGY PLLC
Entity Type:Organization
Organization Name:SOUTHERN COLORADO PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-3500
Mailing Address - Street 1:1600 N GRAND AVE. SUITE 440
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2760
Mailing Address - Country:US
Mailing Address - Phone:719-543-3500
Mailing Address - Fax:719-543-3504
Practice Address - Street 1:1600 N GRAND AVE. SUITE 440
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2760
Practice Address - Country:US
Practice Address - Phone:719-543-3500
Practice Address - Fax:719-543-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service