Provider Demographics
NPI:1124091509
Name:AMERIPATH HOSPITAL SERVICES-FLORIDA LLC
Entity type:Organization
Organization Name:AMERIPATH HOSPITAL SERVICES-FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-697-8378
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:239-275-1164
Practice Address - Fax:239-939-0947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0883936207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10D1041408OtherCLIA
FL10D1058308OtherCLIA
FL250225925Medicaid
FL250225930Medicaid
FL00510OtherBCBS FL
FL250225928Medicaid
FL10D1058308OtherCLIA
FL250225920Medicaid
FL10D1064353OtherCLIA
FL250225907Medicaid
FL250225923Medicaid
FL250225933Medicaid
FL250225935Medicaid
FL250225917Medicaid
FL250225919Medicaid
FL250225921Medicaid
FL250225926Medicaid
FL269370400Medicaid
FL250225927Medicaid
FL250225929Medicaid
FL250225936Medicaid
FL250225929Medicaid
FL250225920Medicaid
FL250225923Medicaid