NPIMap

Organization Active NPI

Southwest Diagnostic Laboratories PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Durango, CO
National Provider Identifier
1982676920
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
06D0518876 Issued in CO
Legal business name
SOUTHWEST DIAGNOSTIC LABORATORIES PC
Practice address
1010 Three Springs Blvd
Durango, CO 81301-8296
Phone
(970) 764-1170
Fax
(970) 764-1108
NPI assigned
Feb 3, 2006
Last updated
Apr 24, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
AMERIPATH INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Dr. Edward M Kramer, MD
Title
Vice President
Phone
(610) 550-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 06D0518876 CO Primary

Addresses

Primary practice location

1010 Three Springs Blvd
Durango, CO 81301-8296

Mailing address

14275 Midway Rd
Suite 400
Addison, TX 75001-3614
Phone (214) 932-8029

Other identifiers 1

IdentifierTypeStateIssuer
04005880MedicaidCO

National Provider Directory

National Provider Directory

Locations

15150 Collections Ctr D
Chicago, IL 60693

15150 Collections Ctr Dr
Chicago, IL 60693

Practitioners & affiliated clinicians

Practitioners 9

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": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1982676920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14275 MIDWAY RD",
            "address_2": "SUITE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013614",
            "telephone_number": "214-932-8029",
            "fax_number": "610-271-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 THREE SPRINGS BLVD",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813018296",
            "telephone_number": "970-764-1170",
            "fax_number": "970-764-1108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DIAGNOSTIC LABORATORIES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMERIPATH INC.",
        "enumeration_date": "2006-02-03",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "610-550-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CO",
            "license": "06D0518876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04005880",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.