Provider Demographics
NPI:1316919079
Name:AMERIPATH INDIANAPOLIS PC
Entity type:Organization
Organization Name:AMERIPATH INDIANAPOLIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-890-6220
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 1:2560 N SHADELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1706
Practice Address - Country:US
Practice Address - Phone:317-275-8005
Practice Address - Fax:317-275-8018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
IN15D1002565291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2884188Medicaid
MN1316919079Medicaid
IN200168060AMedicaid
KY7100184740Medicaid
MI1316919079Medicaid
KY7100063140Medicaid
KY7100063140Medicaid
IL=========001Medicaid