Provider Demographics
NPI:1124441431
Name:MPATH, LLC
Entity type:Organization
Organization Name:MPATH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGERLISA
Authorized Official - Middle Name:WENCHE
Authorized Official - Last Name:MATTOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-818-6788
Mailing Address - Street 1:PO BOX 7268
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0268
Mailing Address - Country:US
Mailing Address - Phone:970-663-2742
Mailing Address - Fax:970-699-0159
Practice Address - Street 1:1708 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4204
Practice Address - Country:US
Practice Address - Phone:970-818-6788
Practice Address - Fax:970-372-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49136207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty