Provider Demographics
NPI:1598842510
Name:NATIONAL HISTOLORY PREP INC
Entity Type:Organization
Organization Name:NATIONAL HISTOLORY PREP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:WHITTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-460-0768
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0028
Mailing Address - Country:US
Mailing Address - Phone:303-460-0768
Mailing Address - Fax:303-460-7364
Practice Address - Street 1:3101 INDUSTRIAL LN
Practice Address - Street 2:UNIT A
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7175
Practice Address - Country:US
Practice Address - Phone:303-460-0768
Practice Address - Fax:303-460-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74152599Medicaid
CO74152599Medicaid