1578535456 NPI number — AMERIPATH CLEVELAND INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578535456 NPI number — AMERIPATH CLEVELAND INC

Employer Identification Number (EIN):

Provider Organization Name:

AMERIPATH CLEVELAND INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

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Provider Other Organization Name:

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Provider Other Last Name Type Code:

NPI Number:

1578535456

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

10/15/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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:

800-331-7546

Provider Business Mailing Address Fax Number:

610-271-4245

Provider First Line Business Practice Location Address:

2451 EDISON BLVD STE A

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TWINSBURG

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44087-2340

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

440-703-2100

Provider Business Practice Location Address Fax Number:

440-703-2155

Provider Enumeration Date:

02/03/2006

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

• Taxonomy code: 291U00000X , with the licence number:  36D0656067 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000024771 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 164729542 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 1718561 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 690031091 . This is a "MC RR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 7001332 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 101272607 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1578535456 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 4104722 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 084918 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: L00234 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 0318525 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 158988709 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
• Identifier: 36201300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 90386574 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".