Healthcare Provider Details

I. General information

NPI: 1710941158
Provider Name (Legal Business Name): MOUNTAIN STATES PATHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

PO BOX 744127
DALLAS TX
75374
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5000
  • Fax:
Mailing address:
  • Phone: 719-776-5816
  • Fax: 719-776-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS WILLIAM FRANQUEMONT
Title or Position: PRESIDENT
Credential: MD
Phone: 719-776-5816