Provider Demographics
NPI:1528581394
Name:BLUE CROWN LABORATORIES
Entity Type:Organization
Organization Name:BLUE CROWN LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:VERITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-359-4211
Mailing Address - Street 1:7300 S COLORADO BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2276
Mailing Address - Country:US
Mailing Address - Phone:719-359-4211
Mailing Address - Fax:719-359-4219
Practice Address - Street 1:7300 S COLORADO BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2276
Practice Address - Country:US
Practice Address - Phone:719-359-4211
Practice Address - Fax:719-359-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D2126398291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory