1205607470 NPI number — AMERIPATH FLORIDA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205607470 NPI number — AMERIPATH FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH FLORIDA LLC
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:
1205607470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-697-8378
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SE HILLMOOR DR STE C11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-7541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-979-8711
Provider Business Practice Location Address Fax Number:
813-972-8267
Provider Enumeration Date:
01/15/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
702-733-7866

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)