1225000201 NPI number — AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC

Table of content: (NPI 1225000201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225000201 NPI number — AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225000201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/04/2011
NPI Reactivation Date:
03/19/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7111 FAIRWAY DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33418-4207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-712-6265
Provider Business Mailing Address Fax Number:
561-712-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27472 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48088-6688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-774-5819
Provider Business Practice Location Address Fax Number:
586-774-5869
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
MICHEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
214-932-8270

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  23D1024436 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L00236 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4727299 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0E01779 . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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