1306817960 NPI number — AMERIPATH 501A CORPORATION

Table of content: (NPI 1306817960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306817960 NPI number — AMERIPATH 501A CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIPATH 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:
COCKERELL AND ASSOCIATES
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:
1306817960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2011
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:
2330 BUTLER ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-309-0000
Provider Business Practice Location Address Fax Number:
214-630-5210
Provider Enumeration Date:
01/31/2006

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:  45D0677505 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7001145 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3790343200 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490764 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420891 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 025447601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132904709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000814734A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32919900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000J6113 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100447800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00018 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122415 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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