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General NPI Number Information
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NPI Number | 1700860434
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Entity Type | Organization
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Legal Business Name | AMERIPATH LUBBOCK 5.01(A) CORPORATION
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1401 PENNSYLVANIA AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-2113
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Country | US
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Telephone | 713-432-1100
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Fax | 713-432-0221
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD SUITE 400
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone |
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Fax | 610-271-4245
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DARREN THOMAS WHEELER
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Credential |
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Telephone | 702-733-7866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 45D0701182
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License Number State | TX
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