1225000201 NPI number — AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC

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 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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