NPIMap

Organization Active NPI

Mountain States Pathology PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Canon City, CO
National Provider Identifier
1922670520
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
MOUNTAIN STATES PATHOLOGY PC
Practice address
1338 Phay Ave
Canon City, CO 81212-2311
Phone
(719) 776-5816
NPI assigned
Jul 13, 2021
Last updated
Jul 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
David Newton, MDNPI 1184689762
Title
President
Phone
(719) 776-5816

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

1338 Phay Ave
Canon City, CO 81212-2311

Mailing address

2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone (719) 776-5816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603000700 CO Part B Supplier - Clinic/Group Practice 4284616293 Receives reassigned benefits from 18 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westminster, CO; Pueblo, CO; Longmont, CO; Lakewood, CO; Frisco, CO; Durango, CO; Fort Morgan, CO; Canon City, CO…

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Pathology PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1922670520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-776-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 PHAY AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812122311",
            "telephone_number": "719-776-5816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES PATHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "NEWTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-776-5816",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.