Integrated Molecular Diagnostics Pathology, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

INTEGRATED MOLECULAR DIAGNOSTICS PATHOLOGY, INC.

Practice address

12635 E Montview Blvd
Ste 360
Aurora, CO 80045-7335

Phone

(303) 961-1773

Fax

(866) 550-3288

NPI assigned

Mar 25, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Israel Villasensor

Title

Executive Vice President/Secretary

Phone

(831) 818-4051

Specialties & licenses 2

Addresses

Other names 1

• IMD Path Doing business as

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

CLIA laboratory certificates

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Path Labs, LLC

  • Clinical Medical Laboratory
  • Sacramento, CA
  • NPI 1710983671

  Member Of

  NPD member
• Pathology Services Inc.

  • Clinical Medical Laboratory
  • Berkeley, CA
  • NPI 1588629919

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1770977951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 THE ALAMEDA",
            "address_2": "STE 530",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261437",
            "telephone_number": "831-818-4051",
            "fax_number": "866-550-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12635 E MONTVIEW BLVD",
            "address_2": "STE 360",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800457335",
            "telephone_number": "303-961-1773",
            "fax_number": "866-550-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MOLECULAR DIAGNOSTICS PATHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-25",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "VILLASENSOR",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/SECRETARY",
        "authorized_official_telephone_number": "831-818-4051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CO",
            "license": "195377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMD Path",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Aurora, CO
• Providers in Aurora, CO by specialty
• Clinical Medical Laboratory in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.