Provider Demographics
NPI:1265474506
Name:FORT COLLINS CONSULTANTS IN PATHOLOGY PC
Entity Type:Organization
Organization Name:FORT COLLINS CONSULTANTS IN PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STASZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-495-8740
Mailing Address - Street 1:1024 LEMAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3929
Mailing Address - Country:US
Mailing Address - Phone:970-495-8740
Mailing Address - Fax:970-495-7605
Practice Address - Street 1:1024 LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-8740
Practice Address - Fax:970-495-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0131OtherRAILROAD MEDICARE
CO04110086Medicaid
CO04110086Medicaid