Healthcare Provider Details

I. General information

NPI: 1780656470
Provider Name (Legal Business Name): AMERIPATH KENTUCKY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

2560 N. SHADELAND AVENUE SUITE A
INDIANAPOLIS IN
46219-1706
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-7094
  • Fax: 859-226-7859
Mailing address:
  • Phone: 317-275-8072
  • Fax: 317-275-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number18D0648517
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number18D0323347
License Number StateKY

VIII. Authorized Official

Name: MR. MICHAEL GREENE
Title or Position: VP
Credential:
Phone: 561-712-6200