Provider Demographics
NPI:1912376245
Name:ANCILLARY PRACTICE, LLC
Entity Type:Organization
Organization Name:ANCILLARY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-339-8758
Mailing Address - Street 1:6629 E HERITAGE PL N
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4667
Mailing Address - Country:US
Mailing Address - Phone:720-339-8758
Mailing Address - Fax:
Practice Address - Street 1:6629 E HERITAGE PL N
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4667
Practice Address - Country:US
Practice Address - Phone:720-339-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory