Provider Demographics
NPI:1265591705
Name:LABORATORIES AT BONFILS
Entity type:Organization
Organization Name:LABORATORIES AT BONFILS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTCHAELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-363-2210
Mailing Address - Street 1:717 YOSEMITE STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6918
Mailing Address - Country:US
Mailing Address - Phone:303-365-9000
Mailing Address - Fax:303-343-6666
Practice Address - Street 1:717 YOSEMITE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6918
Practice Address - Country:US
Practice Address - Phone:303-365-9000
Practice Address - Fax:303-343-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
06HL01Medicare ID - Type Unspecified