Provider Demographics
NPI:1912966458
Name:SUMMIT PATHOLOGY
Entity Type:Organization
Organization Name:SUMMIT PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:WENTZELL
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-350-6400
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:970-212-0553
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:970-212-0530
Practice Address - Fax:970-212-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37647207ZB0001X
CO35098207ZH0000X
CO34496207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73488844Medicaid
CO04116042Medicaid
CO77332041Medicaid
CO61974536Medicaid
CO04116042Medicaid
CO77332041Medicaid
COCE3008Medicare PIN