Healthcare Provider Details

I. General information

NPI: 1396717054
Provider Name (Legal Business Name): AMERIPATH CONSULTING PATHOLOGY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 RUIN CREEK RD SUITE 5
HENDERSON NC
27536-5921
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 252-492-4477
  • Fax: 252-436-1899
Mailing address:
  • Phone: 317-275-8072
  • Fax: 317-275-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D0239955
License Number StateNC

VIII. Authorized Official

Name: MR. MICHAEL H GREENE
Title or Position: VP
Credential:
Phone: 214-932-8270