Healthcare Provider Details

I. General information

NPI: 1316919079
Provider Name (Legal Business Name): AMERIPATH INDIANAPOLIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 N SHADELAND AVE SUITE A
INDIANAPOLIS IN
46219-1706
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 317-275-8005
  • Fax: 317-275-8018
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number15D1002565
License Number StateIN

VIII. Authorized Official

Name: ROBERT QUIREY
Title or Position: AO
Credential: MD
Phone: 800-890-6220