Provider Demographics
NPI:1255304689
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:866-697-2378
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 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:954-633-3387
Practice Address - Fax:954-633-3217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1014540207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250225931Medicaid
FL250225903Medicaid
FL250225902Medicaid
FL250225900Medicaid
FL250225901Medicaid
FL250225918Medicaid
FL250225932Medicaid
FL250225909Medicaid
FL00510OtherBCBS FL
FL250225908Medicaid
FL250225924Medicaid
FL250225934Medicaid
FL250225902Medicaid
FLDE6808Medicare PIN