1205808847 NPI number — ANATOMIC PATHOLOGY SERVICES INC

Table of content: (NPI 1205808847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205808847 NPI number — ANATOMIC PATHOLOGY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANATOMIC PATHOLOGY SERVICES INC
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:
APS
Provider Other Organization Name Type Code:
5
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:
1205808847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
561-712-6200
Provider Business Mailing Address Fax Number:
561-712-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 S UTICA AVE
Provider Second Line Business Practice Location Address:
SUITE 367
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-749-7964
Provider Business Practice Location Address Fax Number:
918-584-0156
Provider Enumeration Date:
02/07/2006

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  37D0473659 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100748070B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188902709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".