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General NPI Number Information
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NPI Number | 1346313822
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Entity Type | Organization
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Legal Business Name | AMERIPATH CONSOLIDATED LABS INC.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 895 SW 30TH AVE SUITE 201
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4887
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Country | US
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Telephone | 800-330-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 7111 FAIRWAY DR SUITE 400
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4207
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Country | US
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Telephone | 561-712-6265
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Fax | 561-712-7349
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Authorized Official
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Title or Position | VP
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Name | MR. MICHAEL H GREENE
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Credential |
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Telephone | 214-932-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D0645438
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License Number State | FL
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