Healthcare Provider Details

I. General information

NPI: 1225205883
Provider Name (Legal Business Name): SALIDA PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RUSH DR
SALIDA CO
81201-9627
US

IV. Provider business mailing address

PO BOX 549
SALIDA CO
81201-0549
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2200
  • Fax: 719-530-2201
Mailing address:
  • Phone: 719-530-2000
  • Fax: 719-530-2055

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: AMY L MULLER
Title or Position: PATHOLOGIST
Credential: MD
Phone: 719-530-2000