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General NPI Number Information
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NPI Number | 1922670520
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATES PATHOLOGY PC
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 1338 PHAY AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2311
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Country | US
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Telephone | 719-776-5816
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 N NEVADA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6819
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Country | US
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Telephone | 719-776-5816
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID NEWTON
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Credential | MD
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Telephone | 719-776-5816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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