Provider Demographics
NPI:1124090154
Name:COLORADO PATHOLOGY CONSULTANTS PC
Entity type:Organization
Organization Name:COLORADO PATHOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-697-8378
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:877-701-8188
Mailing Address - Fax:303-403-3904
Practice Address - Street 1:1600 PRAIRIE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4006
Practice Address - Country:US
Practice Address - Phone:877-701-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D0513643207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1124090154Medicaid
CO04017414Medicaid
CO06D0515651OtherCLIA
CO06D0667646OtherCLIA
COCOM5008OtherBCBS
CO06D0511273OtherCLIA
CO06D1028766OtherCLIA
CO06D0667646OtherCLIA
CO06D0511273OtherCLIA