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General NPI Number Information
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NPI Number | 1912966458
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Entity Type | Organization
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Legal Business Name | SUMMIT PATHOLOGY
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 5802 WRIGHT DR
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City | LOVELAND
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State | CO
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Zip | 80538-8806
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Country | US
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Telephone | 970-212-0530
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Fax | 970-212-0553
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Provider Business Mailing Address
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Address Line | 5802 WRIGHT DR
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City | LOVELAND
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State | CO
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Zip | 80538-8806
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Country | US
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Telephone | 970-212-0530
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Fax | 970-212-0553
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY WENTZELL HAMNER
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Credential | MD
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Telephone | 970-350-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZB0001X
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Taxonomy Name | Blood Banking & Transfusion Medicine Physician
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License Number | 37647
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 35098
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 34496
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License Number State | CO
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