Healthcare Provider Details

I. General information

NPI: 1750442505
Provider Name (Legal Business Name): LOBSS NETWORK SUPPORT 2002
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ARAPAHOE AVE
BOULDER CO
80303-1131
US

IV. Provider business mailing address

PO BOX 9189
MINNEAPOLIS MN
55480-9189
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-4285
  • Fax:
Mailing address:
  • Phone: 888-670-1410
  • Fax: 844-341-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY RENE
Title or Position: DIR NETWORK OPERATIONS
Credential:
Phone: 970-373-3138