Provider Demographics
NPI:1306025697
Name:AMERIPATH FLORIDA LLC
Entity Type:Organization
Organization Name:AMERIPATH FLORIDA LLC
Other - Org Name:BAY AREA DERMATOPATHOLOGY
Other - Org Type:Other Name
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 1:10500 UNIVERSITY CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6497
Practice Address - Country:US
Practice Address - Phone:407-473-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0938449291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL132820Medicaid
FL001057700Medicaid
OH3018531Medicaid
FL10D0938449OtherCLIA
MO1306025697Medicaid
KY7100182350Medicaid
FL800012693OtherAHCA
MI1306025697Medicaid
FL001057700Medicaid