Healthcare Provider Details

I. General information

NPI: 1962508267
Provider Name (Legal Business Name): AMERIPATH LUBBOCK 5.01(A) CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST RANDOL MILL ROAD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 817-460-4366
  • Fax: 817-469-7563
Mailing address:
  • Phone:
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number45D0484474
License Number StateTX

VIII. Authorized Official

Name: DARREN THOMAS WHEELER
Title or Position: VICE PRESIDENT
Credential:
Phone: 702-733-7866