Provider Demographics
NPI:1386220606
Name:FRONT RANGE DERMATOLOGY ASSOCIATES PATHOLOGY LAB
Entity Type:Organization
Organization Name:FRONT RANGE DERMATOLOGY ASSOCIATES PATHOLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-673-1155
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-0069
Mailing Address - Country:US
Mailing Address - Phone:970-673-1155
Mailing Address - Fax:970-673-4747
Practice Address - Street 1:6801 W 20TH ST UNIT 208
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9640
Practice Address - Country:US
Practice Address - Phone:970-673-1155
Practice Address - Fax:970-673-4747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT RANGE DERMATOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory