Provider Demographics
NPI:1710785522
Name:COLORADO STATE UNIVERSITY
Entity type:Organization
Organization Name:COLORADO STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-443-7762
Mailing Address - Street 1:151 W LAKE STREET 8031 CAMPUS DELIVERY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-0001
Mailing Address - Country:US
Mailing Address - Phone:970-491-2213
Mailing Address - Fax:970-408-5099
Practice Address - Street 1:151 W LAKE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4111
Practice Address - Country:US
Practice Address - Phone:970-491-2213
Practice Address - Fax:970-408-5099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory