1528030368 NPI number — AMERIPATH SC INC

Table of content: (NPI 1528030368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528030368 NPI number — AMERIPATH SC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH SC 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:
Provider Other Organization Name Type Code:
6
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:
1528030368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
266 W COLEMAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-5651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-388-6911
Provider Business Practice Location Address Fax Number:
843-388-6917
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
610-550-3003

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  42D2039111 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00106241 . This is a "RR MCR" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 922194685A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00169 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010252296 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810004199 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001264 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com