Provider Demographics
NPI:1689311094
Name:SUMMIT PATHOLOGY
Entity Type:Organization
Organization Name:SUMMIT PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-212-0557
Mailing Address - Street 1:PO BOX 913258
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3168
Mailing Address - Country:US
Mailing Address - Phone:970-212-0530
Mailing Address - Fax:
Practice Address - Street 1:6767 WEST 29TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty