MEDICARE: COLORADO PATHOLOGY CONSULTANTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	06D0513643	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	06D0515651	OTHER	CO	CLIA
4	06D0667646	OTHER	CO	CLIA
5	COM5008	OTHER	CO	BCBS
6	06D0511273	OTHER	CO	CLIA
7	06D1028766	OTHER	CO	CLIA

General Provider Information

NPI Number	:	1124090154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PATHOLOGY CONSULTANTS PC

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:	877-701-8188
Fax Number	:	303-403-3904

Provider Business Practice Location Address
First Line	:	1600 PRAIRIE CENTER PKWY
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4006
Country	:	US
Telephone Number	:	877-701-8188
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KRISTIE M DOLAN
Credential	:
Telephone Number	:	866-697-8378

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	04/04/2022

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