=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447324025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERIPATH LUBBOCK 5.01(A) CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W RANDOL MILL RD 3RD FLOOR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76012-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-960-6225
-----------------------------------------------------
Fax | 817-960-6519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14275 MIDWAY RD SUITE 400
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-3614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 610-271-4245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | DARREN THOMAS WHEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-733-7866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D0484493
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------