Provider Demographics
NPI:1922088772
Name:INTERMOUNTAIN PATHOLOGISTS PC
Entity Type:Organization
Organization Name:INTERMOUNTAIN PATHOLOGISTS PC
Other - Org Name:DRS CANFIELD AND BENZIGER PATHOLOGISTS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-240-7229
Mailing Address - Street 1:PO BOX 2085
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-2085
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4212
Practice Address - Country:US
Practice Address - Phone:970-240-7229
Practice Address - Fax:970-249-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04004743Medicaid
COCN2806OtherRAILROAD MEDICARE
CN2806OtherRAILROAD WORKERS MEDICARE
COCN2806OtherRAILROAD MEDICARE