Healthcare Provider Details

I. General information

NPI: 1457508400
Provider Name (Legal Business Name): AMERIPATH TUCSON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

IV. Provider business mailing address

14275 MIDWAY DRIVE SUITE 400
ADDISON TX
75001-3676
US

V. Phone/Fax

Practice location:
  • Phone: 520-320-7681
  • Fax: 520-320-7684
Mailing address:
  • Phone: 520-320-7681
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number03D0980494
License Number StateAZ

VIII. Authorized Official

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