Healthcare Provider Details

I. General information

NPI: 1568380103
Provider Name (Legal Business Name): AMERIPATH INDIANAPOLIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

4770 REGENT BLVD
IRVING TX
75063-2445
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-7050
  • Fax: 573-458-8399
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A QUIREY
Title or Position: AO
Credential: MD
Phone: 317-275-8111