Provider Demographics
NPI:1073585733
Name:AMERIPATH TUCSON INC
Entity Type:Organization
Organization Name:AMERIPATH TUCSON INC
Other - Org Name:AMERIPATH ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-550-3003
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:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:7227 N 16TH STREET
Practice Address - Street 2:150A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5251
Practice Address - Country:US
Practice Address - Phone:602-441-2042
Practice Address - Fax:602-441-2034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D1033449291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZPENDINGMedicaid
AZ197311Medicaid
NM23270039Medicaid
KY7100198070Medicaid
WY121-190100Medicaid
CO18884211Medicaid
ID8071946Medicaid