Provider Demographics
NPI:1386019495
Name:ADVANCED DIAGNOSTIC FNA BIOPSY CLINIC, LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC FNA BIOPSY CLINIC, LLC
Other - Org Name:PRECISION DIAGNOSTIC FNA BIOPSY CLINC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/CYTOPATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-214-7849
Mailing Address - Street 1:400 S MCCASLIN BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8700
Mailing Address - Country:US
Mailing Address - Phone:970-214-7849
Mailing Address - Fax:
Practice Address - Street 1:400 S. MCCASLIN BLVD.
Practice Address - Street 2:SUITE 213
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:970-214-7849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056076207ZC0500X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty