Provider Demographics
NPI:1275756587
Name:HIGH PLAINS PATHLOGY CONSULTANTS P.C.
Entity Type:Organization
Organization Name:HIGH PLAINS PATHLOGY CONSULTANTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-384-7734
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1080
Mailing Address - Country:US
Mailing Address - Phone:719-384-6577
Mailing Address - Fax:719-384-2441
Practice Address - Street 1:1100 CARSON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2751
Practice Address - Country:US
Practice Address - Phone:719-384-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09-30086207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04004354Medicaid
CO04004354Medicaid
COC10804Medicare ID - Type Unspecified