Provider Demographics
NPI:1306837737
Name:THE PATHOLOGY GROUP PC
Entity Type:Organization
Organization Name:THE PATHOLOGY GROUP PC
Other - Org Name:THE PATHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-256-6266
Mailing Address - Street 1:PO BOX 4235
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502
Mailing Address - Country:US
Mailing Address - Phone:970-256-6463
Mailing Address - Fax:970-549-4140
Practice Address - Street 1:2351 G ROAD
Practice Address - Street 2:COMMUNITY HOSPITAL
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-549-4140
Practice Address - Fax:432-223-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI3527OtherRAILROAD MEDICARE
CO04023412Medicaid
CO04023412Medicaid
COC233308Medicare PIN