Healthcare Provider Details

I. General information

NPI: 1073585733
Provider Name (Legal Business Name): AMERIPATH TUCSON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N 16TH STREET 150A
PHOENIX AZ
85020-5251
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2042
  • Fax: 602-441-2034
Mailing address:
  • Phone: 214-932-8029
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number03D1033449
License Number StateAZ

VIII. Authorized Official

Name: EDWARD MICHAEL KRAMER
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 610-550-3003