Provider Demographics
NPI:1396971123
Name:SUMMIT PATHOLOGY
Entity type:Organization
Organization Name:SUMMIT PATHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:WENTZELL
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-461-6091
Mailing Address - Street 1:5802 WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8806
Mailing Address - Country:US
Mailing Address - Phone:970-212-0530
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:5802 WRIGHT DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8806
Practice Address - Country:US
Practice Address - Phone:800-920-6227
Practice Address - Fax:970-353-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCLIA 06D1024422291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4666Medicare PIN