1801033683 NPI number — AMERIPATH LUBBOCK 501A CORPORATION

Table of content: (NPI 1801033683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801033683 NPI number — AMERIPATH LUBBOCK 501A CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH LUBBOCK 501A CORPORATION
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:
1801033683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/01/2011
NPI Reactivation Date:
09/20/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-8029
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-5151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-627-7000
Provider Business Practice Location Address Fax Number:
575-627-7007
Provider Enumeration Date:
01/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
610-550-3000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07231083 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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