Summit Pathology
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Laramie, WY
NPI 1700523131 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1700523131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- SUMMIT PATHOLOGY
- Practice address
- 255 N 30TH St
Laramie, WY 82072-5140 - Phone
- (307) 755-4440
- NPI assigned
- May 17, 2022
- Organization subpart
- No
Authorized official
- Name
- Jeff Christinson
- Title
- Ceo
- Phone
- (970) 212-0557
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 10
Practitioners 4
-
Michael Justin McFall, D.O.
-
Jason D Sutherland, M.D.
-
Adam Patrick Vogt, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2224755 | Summit Pathology Laboratories, Inc | Compliance | Oct 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150730012393 | WY | Part B Supplier - Clinic/Group Practice | 3971595968 |
Receives reassigned benefits from 22 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Casper, WY; Cheyenne, WY; Laramie, WY |
National Provider Directory
- Tax ID family
- Summit Pathology
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | Yes |
Addresses
Primary practice location
255 N 30TH St
Laramie, WY 82072-5140
Mailing address
PO Box 913258
Denver, CO 80291-3258
Phone (970) 212-0530
Other providers in Laramie, WY
- Deanna Suder
- Summit Chiropractic and Wellness LLC
- Summit Home Health Care
- Summit Home Health Care
- Summit Medical Group, LLC
- Summit View Dentistry, P.C.
- Ajayi Sunday
- Joyce Surdam
- Susan McCabe Aprn BC Inc
- Hannah Sutkowski
All providers in Laramie, WY · Anatomic Pathology & Clinical Pathology Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.