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Summit Pathology

Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Cheyenne, WY

NPI 1164020715 · NPPES record last updated Oct 15, 2020

Key facts

NPI
1164020715
Entity type
Organization (NPI type 2)
Primary specialty
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
Legal business name
SUMMIT PATHOLOGY
Practice address
2301 House Ave Ste 108
Cheyenne, WY 82001-3177
Phone
(307) 274-3057
NPI assigned
Oct 15, 2020
Organization subpart
No

Authorized official

Name
Jeff Christinson
Title
Ceo
Phone
(970) 212-0557

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D2141206Summit Pathology - Cheyenne
2301 House Avenue, Suite 108, Cheyenne, WY 82001		AccreditationNov 5, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150730012393 WY Part B Supplier - Clinic/Group Practice 3971595968 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
Practice locations: Casper, WY; Cheyenne, WY; Laramie, WY

National Provider Directory

Tax ID family
Summit Pathology (11 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207ZB0001X
Hematology (Pathology) Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207ZH0000X
Anatomic Pathology & Clinical Pathology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207ZP0102X Yes

Addresses

Primary practice location

2301 House Ave Ste 108
Cheyenne, WY 82001-3177

Mailing address

PO Box 913258
Denver, CO 80291-3258
Phone (970) 212-0530

Other providers in Cheyenne, WY

All providers in Cheyenne, WY · Anatomic Pathology & Clinical Pathology Physician in Wyoming

Sources for this page

Verify at the official NPI Registry.